{"hospital_name": "Irving Coppell Surgical Hospital LLP", "last_updated_on": "2026-04-14", "version": "3.0.0", "pid": "1549978561", "rid": "12656", "location_name": ["Baylor Surgical Hospital at Las Colinas"], "hospital_address": ["400 I-635 #101b, Irving, TX 75063"], "type_2_npi": ["1669569984"], "license_information": {"license_number": "007995", "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": 465.5, "discounted_cash": 279.3, "setting": "both", "billing_class": "facility"}]}, {"description": "(AYR)/SODUM CHLORIDE 0.65% NASAL GEL 22.5GM", "code_information": [{"code": "MED0306", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 30.9, "discounted_cash": 18.54, "setting": "both", "billing_class": "facility"}]}, {"description": "09MM CURVED VACUUM CURETTE 612", "code_information": [{"code": "612", "type": "CDM"}], "standard_charges": [{"gross_charge": 26.49, "discounted_cash": 15.89, "setting": "both", "billing_class": "facility"}]}, {"description": "1", "code_information": [{"code": "10060201", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 295.0, "discounted_cash": 177.0, "setting": "both", "billing_class": "facility"}]}, {"description": "1 ADMN RSV MONOC ANTB IM NJX", "code_information": [{"code": "96381", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1.3MM/1.8MM SOFT TISSUE PROTECTOR 08-604", "code_information": [{"code": "8-604", "type": "CDM"}], "standard_charges": [{"gross_charge": 1328.4, "discounted_cash": 797.04, "setting": "both", "billing_class": "facility"}]}, {"description": "1.5MM STRAIGHT PLATE 12 HOLES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "246.191", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 894.24, "discounted_cash": 536.54, "setting": "both", "billing_class": "facility"}]}, {"description": "1.5MM X 6MM HEXALOBE MULTISCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3004-15006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 524.0, "discounted_cash": 314.4, "setting": "both", "billing_class": "facility"}]}, {"description": "1.7MM/2.7MM SOFT TISSUE PROT 08-707", "code_information": [{"code": "8-707", "type": "CDM"}], "standard_charges": [{"gross_charge": 1328.4, "discounted_cash": 797.04, "setting": "both", "billing_class": "facility"}]}, {"description": "1.8 X 150MM KWIRE  LANCET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5042.51/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 152.8, "discounted_cash": 91.68, "setting": "both", "billing_class": "facility"}]}, {"description": "1.8MM Q-FIX DISPOSABLE FLEXIBLE DRILL", "code_information": [{"code": "72290118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1202.27, "discounted_cash": 721.36, "setting": "both", "billing_class": "facility"}]}, {"description": "1/2 INCH HEX DRIVER-FEMALE 03.611.139", "code_information": [{"code": "3.611.139", "type": "CDM"}], "standard_charges": [{"gross_charge": 470.84, "discounted_cash": 282.5, "setting": "both", "billing_class": "facility"}]}, {"description": "1/4 INCH HEX DRIVER-FEMALE 03.611.135", "code_information": [{"code": "3.611.135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 470.84, "discounted_cash": 282.5, "setting": "both", "billing_class": "facility"}]}, {"description": "1/4 INCH HEX DRIVER-MALE 03.611.116", "code_information": [{"code": "3.611.116", "type": "CDM"}], "standard_charges": [{"gross_charge": 357.08, "discounted_cash": 214.25, "setting": "both", "billing_class": "facility"}]}, {"description": "1/4 INCH-3/8 INCH WRENCH 03.611.061", "code_information": [{"code": "3.611.061", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.28, "discounted_cash": 252.17, "setting": "both", "billing_class": "facility"}]}, {"description": "1/4 MULT SPAN PL L2.15-2.95 810-423", "code_information": [{"code": "810-423", "type": "CDM"}], "standard_charges": [{"gross_charge": 1360.8, "discounted_cash": 816.48, "setting": "both", "billing_class": "facility"}]}, {"description": "1/8 INCH HEX DRIVER-FEMALE 03.611.131", "code_information": [{"code": "3.611.131", "type": "CDM"}], "standard_charges": [{"gross_charge": 470.84, "discounted_cash": 282.5, "setting": "both", "billing_class": "facility"}]}, {"description": "1/8 INCH HEX DRIVER-MALE 03.611.112", "code_information": [{"code": "3.611.112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 357.08, "discounted_cash": 214.25, "setting": "both", "billing_class": "facility"}]}, {"description": "1/8 QUICK CHUCK W/HALL END 201-78-51", "code_information": [{"code": "201-78-51", "type": "CDM"}], "standard_charges": [{"gross_charge": 412.3, "discounted_cash": 247.38, "setting": "both", "billing_class": "facility"}]}, {"description": "1/8 QUICK CHUCK W/HUDSON END 201-78-52", "code_information": [{"code": "201-78-52", "type": "CDM"}], "standard_charges": [{"gross_charge": 412.3, "discounted_cash": 247.38, "setting": "both", "billing_class": "facility"}]}, {"description": "10.0MM HEX DRIVER-FEMALE 03.611.126", "code_information": [{"code": "3.611.126", "type": "CDM"}], "standard_charges": [{"gross_charge": 470.84, "discounted_cash": 282.5, "setting": "both", "billing_class": "facility"}]}, {"description": "10.5CM-11MM DPHX10MM DI CUTTER 874-350", "code_information": [{"code": "874-350", "type": "CDM"}], "standard_charges": [{"gross_charge": 347.28, "discounted_cash": 208.37, "setting": "both", "billing_class": "facility"}]}, {"description": "10.5CM-11MM DPTHX5MM DI CUTTER 874-345", "code_information": [{"code": "874-345", "type": "CDM"}], "standard_charges": [{"gross_charge": 347.28, "discounted_cash": 208.37, "setting": "both", "billing_class": "facility"}]}, {"description": "10.5CM-11MM DPTHX7MM DI CUTTER 874-347", "code_information": [{"code": "874-347", "type": "CDM"}], "standard_charges": [{"gross_charge": 347.28, "discounted_cash": 208.37, "setting": "both", "billing_class": "facility"}]}, {"description": "10.5CM-11MM DPTHX8MM DI CUTTER 874-348", "code_information": [{"code": "874-348", "type": "CDM"}], "standard_charges": [{"gross_charge": 347.28, "discounted_cash": 208.37, "setting": "both", "billing_class": "facility"}]}, {"description": "10.5CM-11MM DPTHX9MM DI CUTTER 874-349", "code_information": [{"code": "874-349", "type": "CDM"}], "standard_charges": [{"gross_charge": 347.28, "discounted_cash": 208.37, "setting": "both", "billing_class": "facility"}]}, {"description": "10.5MM SOLID TAP 6067.01", "code_information": [{"code": "6067.01", "type": "CDM"}], "standard_charges": [{"gross_charge": 1170.72, "discounted_cash": 702.43, "setting": "both", "billing_class": "facility"}]}, {"description": "10.5MM TAP 624.105", "code_information": [{"code": "624.105", "type": "CDM"}], "standard_charges": [{"gross_charge": 1300.74, "discounted_cash": 780.44, "setting": "both", "billing_class": "facility"}]}, {"description": "100 INSULIN SYRINGES", "code_information": [{"code": "S8490", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "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": 4399.92, "discounted_cash": 2639.95, "setting": "both", "billing_class": "facility"}]}, {"description": "10MM DISTRACTOR / RETRACTOR 606.81", "code_information": [{"code": "606.81", "type": "CDM"}], "standard_charges": [{"gross_charge": 461.36, "discounted_cash": 276.82, "setting": "both", "billing_class": "facility"}]}, {"description": "10MM DISTRACTOR/RETRACTOR 601.91", "code_information": [{"code": "601.91", "type": "CDM"}], "standard_charges": [{"gross_charge": 461.36, "discounted_cash": 276.82, "setting": "both", "billing_class": "facility"}]}, {"description": "10MM LEFT MEDIAL CONGRUENT PERSONA  VIVACIT HIGHLY CROSSLINKED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5121-005-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1575.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "10MM PS LINER FOR TIBIAL PLATE SZ. 9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6535.50.910", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3250.0, "discounted_cash": 1950.0, "setting": "both", "billing_class": "facility"}]}, {"description": "10MM STRAIGHT VACUUM CURETTE 603", "code_information": [{"code": "603", "type": "CDM"}], "standard_charges": [{"gross_charge": 26.49, "discounted_cash": 15.89, "setting": "both", "billing_class": "facility"}]}, {"description": "10MMX26MM BULLET DIST. TIP E900-810", "code_information": [{"code": "E900-810", "type": "CDM"}], "standard_charges": [{"gross_charge": 217.88, "discounted_cash": 130.73, "setting": "both", "billing_class": "facility"}]}, {"description": "10MMX26MM CAM DIST. TIP E900-812", "code_information": [{"code": "E900-812", "type": "CDM"}], "standard_charges": [{"gross_charge": 463.41, "discounted_cash": 278.05, "setting": "both", "billing_class": "facility"}]}, {"description": "10MMX26MM FIXED BULLET DIST. E900-820", "code_information": [{"code": "E900-820", "type": "CDM"}], "standard_charges": [{"gross_charge": 625.63, "discounted_cash": 375.38, "setting": "both", "billing_class": "facility"}]}, {"description": "10MMX26MM FIXED CAM DIST. 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{"description": "10NM TORQUE WRENCH 11MM ACROSS THE FLATS 388.261", "code_information": [{"code": "388.261", "type": "CDM"}], "standard_charges": [{"gross_charge": 3518.64, "discounted_cash": 2111.18, "setting": "both", "billing_class": "facility"}]}, {"description": "11-2616 POWERPRO SAWBLADES 203-90-02", "code_information": [{"code": "203-90-02", "type": "CDM"}], "standard_charges": [{"gross_charge": 183.28, "discounted_cash": 109.97, "setting": "both", "billing_class": "facility"}]}, {"description": "11-2624 POWERPRO SAWBLADE 203-90-01", "code_information": [{"code": "203-90-01", "type": "CDM"}], "standard_charges": [{"gross_charge": 363.4, "discounted_cash": 218.04, "setting": "both", "billing_class": "facility"}]}, {"description": "11-3732 ZIMMER SERIES 3 VERSIPOWERPLUS 90X13X.89 203-97-16", "code_information": [{"code": "203-97-16", "type": "CDM"}], "standard_charges": [{"gross_charge": 363.4, "discounted_cash": 218.04, "setting": "both", "billing_class": "facility"}]}, {"description": "11.0MM CANNULATED TAP 639.211", "code_information": [{"code": "639.211", "type": "CDM"}], "standard_charges": [{"gross_charge": 1300.32, "discounted_cash": 780.19, "setting": "both", "billing_class": "facility"}]}, {"description": "11.5 SIZING PROBE 02-009", "code_information": [{"code": "2-009", "type": "CDM"}], "standard_charges": [{"gross_charge": 2002.32, "discounted_cash": 1201.39, "setting": "both", "billing_class": "facility"}]}, {"description": "11355055 ROD RELINE 5.5 X 55 MM LORDOTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11355055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2758.0, "discounted_cash": 1654.8, "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": 4399.92, "discounted_cash": 2639.95, "setting": "both", "billing_class": "facility"}]}, {"description": "11G PEDICLE TARGETING CANNULA 04-JAMCANN-11", "code_information": [{"code": "4-JAMCANN-11", "type": "CDM"}], "standard_charges": [{"gross_charge": 418.7, "discounted_cash": 251.22, "setting": "both", "billing_class": "facility"}]}, {"description": "11G PEDICLE TARGETING TROCAR 04-JAMTROCAR-11", "code_information": [{"code": "4-JAMTROCAR-11", "type": "CDM"}], "standard_charges": [{"gross_charge": 492.1, "discounted_cash": 295.26, "setting": "both", "billing_class": "facility"}]}, {"description": "11G X 4IN SIDE-FIRE NEEDLE 283904411", "code_information": [{"code": "283904411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 478.8, "discounted_cash": 287.28, "setting": "both", "billing_class": "facility"}]}, {"description": "11G X 6IN SIDE-FIRE NEEDLE 283904611", "code_information": [{"code": "283904611", "type": "CDM"}], "standard_charges": [{"gross_charge": 478.8, "discounted_cash": 287.28, "setting": "both", "billing_class": "facility"}]}, {"description": "11MM CURVED VACUUM CURETTE 614", "code_information": [{"code": "614", "type": "CDM"}], "standard_charges": [{"gross_charge": 26.49, "discounted_cash": 15.89, "setting": "both", "billing_class": "facility"}]}, {"description": "11MM HEX DRIVER-12 POINT 03.611.076", "code_information": [{"code": "3.611.076", "type": "CDM"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 284.4, "setting": "both", "billing_class": "facility"}]}, {"description": "11MM OFFSET CONNECTOR   OPEN 8976011", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8976011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2190.0, "discounted_cash": 1314.0, "setting": "both", "billing_class": "facility"}]}, {"description": "11MM STRAIGHT VACUUM CURETTE 604", "code_information": [{"code": "604", "type": "CDM"}], "standard_charges": [{"gross_charge": 26.49, "discounted_cash": 15.89, "setting": "both", "billing_class": "facility"}]}, {"description": "12  LONG  FRAZIER SUCTION TUBE  CLLAT 38-SUCTION-12", "code_information": [{"code": "38-SUCTION-12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 310.94, "discounted_cash": 186.56, "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": 182.83, "maximum": 8427.0, "gross_charge": 389.0, "discounted_cash": 233.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 213.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 182.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 194.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 202.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "12 Lead EKG w/o interp 93005", "code_information": [{"code": "93005", "type": "CPT"}, {"code": 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[{"gross_charge": 2239.92, "discounted_cash": 1343.95, "setting": "both", "billing_class": "facility"}]}, {"description": "2.5MM HEX DRIVER-MALE 03.611.101", "code_information": [{"code": "3.611.101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 357.08, "discounted_cash": 214.25, "setting": "both", "billing_class": "facility"}]}, {"description": "2.5MM X 12MM HEADLESS SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FX-HL-2512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 990.0, "discounted_cash": 594.0, "setting": "both", "billing_class": "facility"}]}, {"description": "2.5MM/3.5MM SOFT TISSUE PROT 08-710", "code_information": [{"code": "8-710", "type": "CDM"}], "standard_charges": [{"gross_charge": 1328.4, "discounted_cash": 797.04, "setting": "both", "billing_class": "facility"}]}, {"description": "2.5NM TORQUE LIMITING HANDLE WITH QUICK COUPLING 389.482", "code_information": [{"code": "389.482", "type": "CDM"}], "standard_charges": [{"gross_charge": 4149.36, "discounted_cash": 2489.62, "setting": "both", "billing_class": "facility"}]}, {"description": "2.7MM TAP 03-9000-14", "code_information": [{"code": "3-9000-14", "type": "CDM"}], "standard_charges": [{"gross_charge": 867.16, "discounted_cash": 520.3, "setting": "both", "billing_class": "facility"}]}, {"description": "2.8 X 16MM CORTEX SCREW GOLD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5800.32/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 463.2, "discounted_cash": 277.92, "setting": "both", "billing_class": "facility"}]}, {"description": "2.8 X 30MM LOCKING SCREW BLUE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-5850.30/1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 758.4, "discounted_cash": 455.04, "setting": "both", "billing_class": "facility"}]}, 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"6595.50.026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "26MM X 10MM X 10MM  5 DEGREE PLIF  CALIX PC X034-0391PC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "X034-0391PC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "26MM X 10MM X 10MM PLIF  CALIX PC X034-0242PC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "X034-0242PC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "26MM X 10MM X 11MM  5 DEGREE PLIF  CALIX PC X034-0392PC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "x034-0392pc", "type": 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"type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "26MM X 10MM X 9MM  5 DEGREE PLIF  CALIX PC X034-0390PC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "X034-0390PC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "270-MICRON FIBER  DORNIER THULIO 270-MICRON FIBER", "code_information": [{"code": "DORNIER THULIO 270-MICRON FIBER", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1061.34, "discounted_cash": 636.8, "setting": "both", "billing_class": "facility"}]}, {"description": "28MM DIA COCR MOD HD STD NK NO SKIRT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "163662", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3042.0, "discounted_cash": 1825.2, "setting": "both", "billing_class": "facility"}]}, {"description": "2NM TORQUE LIMITING HANDLE WITH QUICK COUPLING 03.614.035", "code_information": [{"code": "3.614.035", "type": "CDM"}], "standard_charges": [{"gross_charge": 3337.2, "discounted_cash": 2002.32, "setting": "both", "billing_class": "facility"}]}, {"description": "2NM TORQUE LIMITING HANDLE WITH QUICK COUPLING 389.471", "code_information": [{"code": "389.471", "type": "CDM"}], "standard_charges": [{"gross_charge": 3507.84, "discounted_cash": 2104.7, "setting": "both", "billing_class": "facility"}]}, {"description": "2VHPV VACCINE 3 DOSE IM", "code_information": [{"code": "90650", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO 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"discounted_cash": 1555.2, "setting": "both", "billing_class": "facility"}]}, {"description": "3.3 DRILL BIT 2.5MM", "code_information": [{"code": "2107-3325", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 204.91, "discounted_cash": 122.95, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5  4.0 CANN CRUCIATE DRIVER 03-4000-25", "code_information": [{"code": "3-4000-25", "type": "CDM"}], "standard_charges": [{"gross_charge": 1263.6, "discounted_cash": 758.16, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5 LCP HUMERAL PLATE 2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.123.021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4542.22, "discounted_cash": 2725.33, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5 MM TAP 14-510020", "code_information": [{"code": "14-510020", "type": "CDM"}], "standard_charges": 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"discounted_cash": 270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5MM HEX DRIVER   SHORT 624.708", "code_information": [{"code": "624.708", "type": "CDM"}], "standard_charges": [{"gross_charge": 1122.52, "discounted_cash": 673.51, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5MM HEX DRIVER  1/4 CONNECT  LONG 634.706", "code_information": [{"code": "634.706", "type": "CDM"}], "standard_charges": [{"gross_charge": 805.98, "discounted_cash": 483.59, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5MM HEX DRIVER  REDUCTION SHAFT 634.403", "code_information": [{"code": "634.403", "type": "CDM"}], "standard_charges": [{"gross_charge": 731.5, "discounted_cash": 438.9, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5MM HEX DRIVER  RIGID SHAFT 634.703", "code_information": [{"code": "634.703", "type": "CDM"}], "standard_charges": [{"gross_charge": 1122.52, "discounted_cash": 673.51, "setting": 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"both", "billing_class": "facility"}]}, {"description": "3.5MM SELF-RETAINING HEX DRIVER  1/4 CONNECT 624.551", "code_information": [{"code": "624.551", "type": "CDM"}], "standard_charges": [{"gross_charge": 805.98, "discounted_cash": 483.59, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5MM TAP 6905765EV1", "code_information": [{"code": "6905765EV1", "type": "CDM"}], "standard_charges": [{"gross_charge": 1638.79, "discounted_cash": 983.27, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5MM TORQUE LIMITING DRIVER  RATCHETING  1/4 CONNECT  SS 634.611", "code_information": [{"code": "634.611", "type": "CDM"}], "standard_charges": [{"gross_charge": 3095.28, "discounted_cash": 1857.17, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5MM TORQUE LIMITING DRIVER 6041.0604", "code_information": [{"code": "6041.0604", "type": "CDM"}], "standard_charges": [{"gross_charge": 4313.52, "discounted_cash": 2588.11, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5MM X 10MM FIXED TAP 26-FTAP-35-10", "code_information": [{"code": "26-FTAP-35-10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5MM X 12MM FIXED TAP 26-FTAP-35-12", "code_information": [{"code": "26-FTAP-35-12", "type": "CDM"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5MM X 14MM FIXED TAP 26-FTAP-35-14", "code_information": [{"code": "26-FTAP-35-14", "type": "CDM"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5MM X 80 STRAIGHT ROD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1101-53580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5MM/4.0MM VARIABLE TAP 23-35-VTAP", "code_information": [{"code": "23-35-VTAP", "type": "CDM"}], "standard_charges": [{"gross_charge": 591.85, "discounted_cash": 355.11, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5MM/4.0MM X 12MM FIXED TAP 23-35-FTAP-12", "code_information": [{"code": "23-35-FTAP-12", "type": "CDM"}], "standard_charges": [{"gross_charge": 591.85, "discounted_cash": 355.11, "setting": "both", "billing_class": "facility"}]}, {"description": "3.5MM/4.0MM X 14MM FIXED TAP 23-35-FTAP-14", "code_information": [{"code": "23-35-FTAP-14", "type": "CDM"}], "standard_charges": [{"gross_charge": 591.85, "discounted_cash": 355.11, "setting": "both", "billing_class": "facility"}]}, {"description": "3.8 COUNTERSINK GREY HCS-070-38", "code_information": [{"code": "HCS-070-38", "type": "CDM"}], "standard_charges": [{"gross_charge": 462.84, "discounted_cash": 277.7, "setting": "both", "billing_class": "facility"}]}, {"description": "3/16 INCH HEX DRIVER-FEMALE 03.611.133", "code_information": [{"code": "3.611.133", "type": "CDM"}], "standard_charges": [{"gross_charge": 470.84, "discounted_cash": 282.5, "setting": "both", "billing_class": "facility"}]}, {"description": "3/16 INCH HEX DRIVER-MALE 03.611.114", "code_information": [{"code": "3.611.114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 357.08, "discounted_cash": 214.25, "setting": "both", "billing_class": "facility"}]}, {"description": "3/8 INCH HEX DRIVER-FEMALE 03.611.137", "code_information": [{"code": "3.611.137", "type": "CDM"}], "standard_charges": [{"gross_charge": 470.84, "discounted_cash": 282.5, "setting": "both", "billing_class": "facility"}]}, {"description": "36MM SIZE D  POLYTHYLENE LINER FOR THE G7 ACETABUALR SYSTEM  20103604", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "20103604", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1125.0, "discounted_cash": 675.0, "setting": "both", "billing_class": "facility"}]}, {"description": "39 +4 LAT/24 GLENOSPHERE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9564-2439-LAT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2254.0, "discounted_cash": 1352.4, "setting": "both", "billing_class": "facility"}]}, {"description": "3AF2535-1513 / ALIF F3D 25MM X 35MM X 13MM 15 DEGREE 3AF2535-1513", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2535-1513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6500.0, "discounted_cash": 3900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "3D ECHO IMG CGEN CAR ANOMAL", "code_information": [{"code": "93319", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "3D RENDER W/INTRP POSTPROCES", "code_information": [{"code": "76376", "type": "CPT"}], "standard_charges": [{"minimum": 68.25, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 68.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 137.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 137.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 144.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 129.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 96.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "3D VOL IMG&RCNSTJ BRST/AX", "code_information": [{"code": "694T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 4173.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "3D contour simulation of target liver lesion(s) and margin(s) for image-guided percutaneous microwave ablation", "code_information": [{"code": "944T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA 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44.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "8G PEDICLE TARGETING TROCAR 04-JAMTROCAR-08", "code_information": [{"code": "4-JAMTROCAR-08", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 492.1, "discounted_cash": 295.26, "setting": "both", "billing_class": "facility"}]}, {"description": "8MM BLADELESS OPTICAL OBTURATOR, LONG", "code_information": [{"code": "470360", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 124.8, "discounted_cash": 74.88, "setting": "both", "billing_class": 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"standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABDOMINAL PAD 5 X 9\" PRM21450", "code_information": [{"code": "PRM21450", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.43, "discounted_cash": 0.26, "setting": "both", "billing_class": "facility"}]}, {"description": "ABDOMINAL PARACENTESIS-INITIAL 49080", "code_information": [{"code": "49080", "type": "CPT"}, {"code": "1479859", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABDOMINOPLASTY 15847", "code_information": [{"code": "15847", "type": "CPT"}, {"code": "1479860", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 602.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1211.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1211.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1274.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1147.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 854.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 878.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 746.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD", "code_information": [{"code": "33254", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ENDO", "code_information": [{"code": "33265", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS ADD-ON", "code_information": [{"code": "33259", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS EXTEN", "code_information": [{"code": "33256", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/O BYPASS EXT", "code_information": [{"code": "33255", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ADD-ON", "code_information": [{"code": "33258", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ENDO", "code_information": [{"code": "33266", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET 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CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20983", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33250", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33251", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33261", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "93650", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 15456.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATION LIVER TUMOR-CRYOSURGICAL 47371", "code_information": [{"code": "47371", "type": "CPT"}, {"code": "1479866", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 16185.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATION TUMOR BLADDER LASER 51020", "code_information": [{"code": "51020", "type": "CPT"}, {"code": "1479867", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATION-OPEN-OF 1 OR MORE LIVER TUMORS; RADIOFREQUENCY 47380", "code_information": [{"code": "47380", "type": "CPT"}, {"code": "1482031", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATOR 50  APOLLO RF H50 ASPIRATING  AR-9835", "code_information": [{"code": "AR-9835", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 989.52, "discounted_cash": 593.71, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLATOR 90 APOLLORF X90 ASPIRATING", "code_information": [{"code": "AR-9821", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 505.4, "discounted_cash": 303.24, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLTJ B9 THYR NDUL PERQ LASR", "code_information": [{"code": "673T", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", 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"standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee 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GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}], "standard_charges": [{"minimum": 684.01, "maximum": 804.77, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 804.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 684.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO Group by Blood Center 86900", "code_information": [{"code": "86900", "type": "CPT"}, {"code": "634326", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "gross_charge": 147.0, "discounted_cash": 88.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 74.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 74.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 78.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 71.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 52.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59840", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59841", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59850", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59851", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59852", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59855", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO 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6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59856", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59857", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [{"code": "770", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7838.39, "maximum": 23438.51, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14461.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 19841.44, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 22266.74, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 23438.51, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 21094.98, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 15704.22, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7838.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION WITHOUT D&C", "code_information": [{"code": "779", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5536.56, "maximum": 10602.5, "estimated_discounted_cash": 9171.61, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10602.5, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5536.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABS SHORT FIXED-DEVICE 5MM/1-USE 20TACK ABSTACK20S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ABSTACK20S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1436.48, "discounted_cash": 861.89, "setting": "both", "billing_class": "facility"}]}, {"description": "ABSCESS DRAINAGE UNDER X-RAY", "code_information": [{"code": "75989", "type": "CPT"}], "standard_charges": [{"minimum": 550.48, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 550.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1105.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1105.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1163.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1047.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 779.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABSORBABLE GELATIN  SPONGE (SURGIFOAM) SIZE 12-7", "code_information": [{"code": "MED0001", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 28.5, "discounted_cash": 17.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ABSORBABLE GELATIN POWDER (SURGIFOAM) KIT 1GM", "code_information": [{"code": "MED0002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 191.85, "discounted_cash": 115.11, "setting": "both", "billing_class": "facility"}]}, {"description": "ABSORBABLE GELATIN POWDER; 1GM ENVELOPE", "code_information": [{"code": "MED0003", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 191.85, "discounted_cash": 115.11, "setting": "both", "billing_class": "facility"}]}, {"description": "ABSORBABLE GELATIN SPONGE (SURGIFOAM) SIZE 100", "code_information": [{"code": "MED0004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.62, "discounted_cash": 96.97, "setting": "both", "billing_class": "facility"}]}, {"description": "ABSORBENT PLUS CO2  1.0 L PREFILLED G-CAN 2105489-003", "code_information": [{"code": "2105489-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.67, "discounted_cash": 43.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABX IRRIGATION SOLUTION 1000 ML", "code_information": [{"code": "MED0570", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 232.5, "discounted_cash": 139.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESS NEEDLE  11 GA 144-020", "code_information": [{"code": "144-020", "type": "CDM"}], "standard_charges": [{"gross_charge": 187.2, "discounted_cash": 112.32, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESS NEEDLE SHEATH 144-018", "code_information": [{"code": "144-018", "type": "CDM"}], "standard_charges": [{"gross_charge": 187.2, "discounted_cash": 112.32, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESS NEEDLE STYLET 95-8012", "code_information": [{"code": "95-8012", "type": "CDM"}], "standard_charges": [{"gross_charge": 319.16, "discounted_cash": 191.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESS PORT 12MM AIRSEAL", "code_information": [{"code": "IAS12-120LPI", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.4, "discounted_cash": 99.84, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESS PORT 8MM OBTURATOR W BLADESS TIP IAS8-120LP", "code_information": [{"code": "IAS8-120LP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 178.88, "discounted_cash": 107.33, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMN RSV MONOC ANTB IM CNSL", "code_information": [{"code": "96380", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO 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"plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 40.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 40.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADPTOR 2570021 LOOP SLAP 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"standard_charges": [{"gross_charge": 11.46, "discounted_cash": 6.88, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASO 34FR ROBERTAZZI ROUNDED TIP TRUMPET DESIGN MEDIPRENE LF", "code_information": [{"code": "1231-34", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.3, "discounted_cash": 8.58, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASOPAHRYNGEAL ROBERTAZZI 28FR LF", "code_information": [{"code": "1-5075-28", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.34, "discounted_cash": 19.4, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASOPAHRYNGEAL ROBERTAZZI 30FR LF", "code_information": [{"code": "1-5075-30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.45, "discounted_cash": 20.07, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASOPAHRYNGEAL ROBERTAZZI 32FR LF", "code_information": [{"code": "1-5075-32", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.43, "discounted_cash": 18.26, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASOPAHRYNGEAL ROBERTAZZI 34FR LF", "code_information": [{"code": "1-5075-34", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.45, "discounted_cash": 20.07, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASOPHARYNGEAL 34FR PVC", "code_information": [{"code": "NA34FR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.11, "discounted_cash": 5.47, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASOPHARYNGEAL ROBERTAZZI 30FR LF 123130", "code_information": [{"code": "123130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.9, "discounted_cash": 6.54, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY ORAL GUEDEL 10MM SZ 5 RED", "code_information": [{"code": "1226100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.14, "discounted_cash": 1.28, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY ORAL GUEDEL 80MM SZ 3 122680", "code_information": [{"code": "122680", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.14, "discounted_cash": 1.28, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY ORAL GUEDEL 90MM SZ 4 YELLOW", "code_information": [{"code": "122690", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.19, "discounted_cash": 1.31, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY ORAL GUEDEL CATH-GUIDE 120MM 1165", "code_information": [{"code": "1165", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.98, "discounted_cash": 3.59, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY ORALPHARYNGEAL TRADITIONAL SZ 0 ISO SZ 5 50MM GUEDEL ECONOMY NON STRL", "code_information": [{"code": "122250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.79, "discounted_cash": 1.07, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY OROPHARYNGEAL SZ 11 110MM ORANGE GUEDEL COLOR CODED POLYETHYLENE LF", "code_information": [{"code": "1161", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.11, "discounted_cash": 4.27, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY PHARYNGEAL 100MM GUEDEL NON STRL DISP", "code_information": [{"code": "1222100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.4, "discounted_cash": 1.44, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY PHARYNGEAL 100MM RED GUEDEL COLOR CODED BITE BLOCK SEMI RIGID NON TOXIC P", "code_information": [{"code": "1160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.05, "discounted_cash": 2.43, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY PHARYNGEAL 60MM GUEDEL NON STRL DISP", "code_information": [{"code": "122260", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.79, "discounted_cash": 1.07, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY PHARYNGEAL 60MM SM CLR COLOR CODED LF", "code_information": [{"code": "1156", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.16, "discounted_cash": 1.3, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY PHARYNGEAL 70MM GUEDEL NON STRL DISP", "code_information": [{"code": "122270", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.79, "discounted_cash": 1.07, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY PHARYNGEAL 70MM WHT GUEDEL COLOR CODED BITE BLOCK SEMI RIGID NON TOXIC PO", "code_information": [{"code": "1157", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.28, "discounted_cash": 1.37, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY PHARYNGEAL 80MM GRN GUEDEL COLOR CODED BITE BLOCK SEMI RIGID NON TOXIC PO", "code_information": [{"code": "1158", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.28, "discounted_cash": 1.37, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY PHARYNGEAL 80MM GUEDEL NON STRL DISP", "code_information": [{"code": "122280", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.79, "discounted_cash": 1.07, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY PHARYNGEAL 90MM GUEDEL NON STRL DISP", "code_information": [{"code": "122290", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.79, "discounted_cash": 1.07, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY PHARYNGEAL 90MM YELLOW GUEDEL COLOR CODED BITE BLOCK SEMI RIGID NON TOXIC", "code_information": [{"code": "1159", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.05, "discounted_cash": 2.43, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY ROBERTAZZI NASOPHARYNGEAL 28 FR 123128", "code_information": [{"code": "123128", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.17, "discounted_cash": 6.7, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY SILICONE W/PILOT BALLOON SZ 2 HUD300000020", "code_information": [{"code": "HUD300000020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.34, "discounted_cash": 19.4, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAYINTUBATION 80MM WHT OVASSAPIAN FOR USE W/ FIBEROPTIC ENDOSCOPE", "code_information": [{"code": "BD6075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.44, "discounted_cash": 15.26, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWY RESIST BY OSCILLOMETRY", "code_information": [{"code": "94728", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 5%, 250 ML", "code_information": [{"code": "P9045", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN),5%, 50ML", "code_information": [{"code": "P9041", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUMIN ISCHEMIA MODIFIED", "code_information": [{"code": "82045", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 213.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 429.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 429.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 452.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 406.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 302.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 99.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 84.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0008", "type": "HCPCS"}], "standard_charges": [{"minimum": 1114.0, "maximum": 1592.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 1592.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 1114.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 1178.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 1244.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0011", "type": "HCPCS"}], "standard_charges": [{"minimum": 1114.0, "maximum": 1592.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 1592.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 1114.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 1178.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 1244.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0012", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 67.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0013", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 67.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0014", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 67.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 57.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 64.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0015", "type": "HCPCS"}], "standard_charges": [{"minimum": 175.0, "maximum": 250.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 250.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 175.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 185.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 194.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0017", "type": "HCPCS"}], "standard_charges": [{"minimum": 645.0, "maximum": 924.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 924.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 645.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 682.0, "methodology": "per diem"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 723.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR 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SYSTEM CAGE VARIABLE ANGLE SCREW S 128 4.5MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1028-453-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALIGNMENT TOOL 03.614.034", "code_information": [{"code": "3.614.034", "type": "CDM"}], "standard_charges": [{"gross_charge": 1204.98, "discounted_cash": 722.99, "setting": "both", "billing_class": "facility"}]}, {"description": "ALIGNMENT TOOL 389.479", "code_information": [{"code": "389.479", "type": "CDM"}], "standard_charges": [{"gross_charge": 1266.16, "discounted_cash": 759.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ALL POLY PAT VE 29 MM DIA 42540200029", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42540200029", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2990.0, "discounted_cash": 1794.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALL POLY PAT VE 32 MM DIA 42540200032", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42540200032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2990.0, "discounted_cash": 1794.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLERGEN SPECIFIC IGG", "code_information": [{"code": "86001", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 78.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 78.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 82.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 74.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 55.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 22.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 19.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGIC REACTIONS WITH MCC", "code_information": [{"code": "915", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12308.45, "maximum": 19711.26, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 19711.26, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12308.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [{"code": "916", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4663.1, "maximum": 7532.22, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7532.22, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4663.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLERGY PATCH TESTS", "code_information": [{"code": "95044", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE MULTIALLG SCR", "code_information": [{"code": "86005", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 131.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 131.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 137.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 124.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 92.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 23.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 19.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE RECOMB EA", "code_information": [{"code": "86008", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 12.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 12.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 13.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 11.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 8.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 52.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 44.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLODERM THICK 44CM SQ SMALL", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "CS1520P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5554.0, "discounted_cash": 3332.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [{"code": "14", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 54.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 59.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 44.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "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": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALLOGRAFT - POSTERIOR VNEW DECELLULARIZED DERMAL ARM0711P", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ARM0711P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5590.0, "discounted_cash": 3354.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT 10CC OSTEOAMP SELECT FIBERS OASF-10", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "OASF-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6521.94, "discounted_cash": 3913.16, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT 2.0 CC AMNIOTIC MEMBRANE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ABP-5200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6487.0, "discounted_cash": 3892.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT 2.7X18 PIP", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "TFF-2718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3300.82, "discounted_cash": 1980.49, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT 2.7X18A PIP", "code_information": [{"code": "L8658", "type": "HCPCS"}, {"code": "TFF-2718A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4927.0, "discounted_cash": 2956.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT 28 X 28 X 7 12MM ALIF", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "L2-ALIF-1208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9347.47, "discounted_cash": 5608.48, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT 3.5MM X 20MM 3520BD", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3520BD", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11050.0, "discounted_cash": 6630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT 4 X 4CM THICK FLOWERDERM  FDM494", "code_information": [{"code": "Q4179", "type": "HCPCS"}, {"code": "FDM494", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 5187.0, "discounted_cash": 3112.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT ACELLULAR AMNIOTIC MEMBRANE 3CM X 5CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "M1012BR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5200.0, "discounted_cash": 3120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT ACELLULAR AMNIOTIC MEMBRANE 3CM X 7CM OVAL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "M1017BR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5200.0, "discounted_cash": 3120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT ACF 11 X 14 X 6MM STERIGRAFT CERVICAL 5DEG LORDOSED", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "70506", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5101.2, "discounted_cash": 3060.72, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT ACF 11X14 7MM  70507", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "70507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5101.2, "discounted_cash": 3060.72, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT ACHILLES TEN-BONE BLOCK FATB", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "FATB", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4575.48, "discounted_cash": 2745.29, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT ACUPAC X 2.5CC 90-1X400002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "90-1X400002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2326.8, "discounted_cash": 1396.08, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRAFT ALLOPATCH PLIABLE DERMAL MATRIX 4 X 4CM 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 386.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 287.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 49.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS QUANT 2-5", "code_information": [{"code": "82136", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 131.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 265.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"CIGNA DFW", "standard_charge_dollar": 57.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 48.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS SINGLE QUANT", "code_information": [{"code": "82131", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 230.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 67.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 57.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND MEMBRANE 3CM X 4CM", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "WC3034", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 2730.0, "discounted_cash": 1638.0, "setting": "both", 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 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"standard_charges": [{"gross_charge": 5460.0, "discounted_cash": 3276.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AMNIOTIC FLUID SCAN", "code_information": [{"code": "82143", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 59.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 119.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 119.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 125.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 113.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", 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"standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 59.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 120.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 120.4, "methodology": "fee schedule"}, {"payer_name": 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"maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 18.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 37.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "24925", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee 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"methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, 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"methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, 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"UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION PENIS-COMPLETE 54125", "code_information": [{"code": "54125", "type": "CPT"}, {"code": "1479903", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION PENIS-PARTIAL 54120", "code_information": [{"code": "54120", "type": "CPT"}, {"code": "1479904", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee 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"payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION REVISION STUMP LOWER LEG 27886", "code_information": [{"code": "27886", "type": "CPT"}, {"code": "1479906", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO 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"standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANG BLADE HOOK 6.5 179752026", "code_information": [{"code": "179752026", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANG BLADE HOOK 8.0 179752028", "code_information": [{"code": "179752028", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGINA PECTORIS", "code_information": [{"code": "311", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5044.05, "maximum": 7920.12, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7920.12, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 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[{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGLED HOOK LEFT - SMALL 10-21-1604-L", "code_information": [{"code": "10-21-1604-L", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGLED HOOK LEFT SMALL 25-21-1604-L", "code_information": [{"code": "25-21-1604-L", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGLED HOOK NARROW   LEFT 7241123", "code_information": [{"code": "7241123", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGLED HOOK NARROW   RIGHT 7241122", "code_information": [{"code": "7241122", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGLED HOOK RIGHT - SMALL 10-21-1604-R", "code_information": [{"code": "10-21-1604-R", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGLED HOOK RIGHT SMALL 25-21-1604-R", "code_information": [{"code": "25-21-1604-R", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGLED LAMINA HOOK THREADED  LARGE  CREO 1119.9857", "code_information": [{"code": "1119.9857", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGLED LAMINA HOOK THREADED  MEDIUM  CREO 1119.9856", "code_information": [{"code": "1119.9856", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGLED LAMINA HOOK THREADED  SMALL  CREO 1119.9855", "code_information": [{"code": "1119.9855", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGLED LAMINA HOOK/ DUAL-OPENING SIDE 298.206", "code_information": [{"code": "298.206", "type": "CDM"}], "standard_charges": [{"gross_charge": 1260.84, "discounted_cash": 756.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGLED LEFT HOOK 57-3020", "code_information": [{"code": "57-3020", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGLED RIGHT HOOK 57-3021", "code_information": [{"code": "57-3021", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANNULAR CLOSURE DEVICE (ACD) BARRICAID DISC PROLAPSE REPAIR IMPLANT 8MM WIDTH BAR-A8-8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "BAR-A8-8MM", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANOGENITAL EXAM CHILD W IMAG", "code_information": [{"code": "99170", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOPLASTY FOR STRICTURE-ADULT 46700", "code_information": [{"code": "46700", "type": "CPT"}, {"code": "1479922", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY", "code_information": [{"code": "46615", "type": 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY AND DILATION", "code_information": [{"code": "46604", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 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55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANS PARASYMP & SYMP W/TILT", "code_information": [{"code": "95924", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE 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"code_information": [{"code": "111050", "type": "CDM"}], "standard_charges": [{"gross_charge": 180.13, "discounted_cash": 108.08, "setting": "both", "billing_class": "facility"}]}, {"description": "ANT CERVICAL DISC PK 0657N41ACLA3", "code_information": [{"code": "657N41ACLA3", "type": "CDM"}], "standard_charges": [{"gross_charge": 401.58, "discounted_cash": 240.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ANT SGM IMG I&R SPECLR MIC", "code_information": [{"code": "92286", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 73.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 21.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 18.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN III ACTIVITY", "code_information": [{"code": "85300", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 270.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 243.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 181.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 29.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN III ANTIGEN", "code_information": [{"code": "85301", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 97.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 195.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 195.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 205.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 184.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 137.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 31.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 26.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTMC GUIDE 3D PRINT EA ADDL", "code_information": [{"code": "562T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 4173.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": 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[{"gross_charge": 316.0, "discounted_cash": 189.6, "setting": "both", "billing_class": "facility"}]}, {"description": "AO SYNTHES/SODEM L90/W19MM .040/1MM 11-2891AUS", "code_information": [{"code": "11-2891AUS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 189.6, "setting": "both", "billing_class": "facility"}]}, {"description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [{"code": "268", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34236.0, "maximum": 75623.92, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 75623.92, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 41856.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 66628.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 34236.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 56634.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 65267.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [{"code": "269", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34236.0, "maximum": 66628.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 47190.66, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 41856.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 66628.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 34236.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 56634.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 40413.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AORTIC CIRCULATION ASSIST", "code_information": [{"code": "33970", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC CIRCULATION ASSIST", "code_information": [{"code": "33971", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC DYSFUNCTION/DILATION", "code_information": [{"code": "81410", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 222.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 222.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 234.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 210.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 156.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1475.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1254.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC DYSFUNCTION/DILATION", "code_information": [{"code": "81411", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3953.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3360.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC HEMIARCH GRAFT", "code_information": [{"code": "33866", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC SUSPENSION", "code_information": [{"code": "33800", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC GENE DUP/DELET VARIANTS", "code_information": [{"code": "81203", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1601.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1441.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1072.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 585.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 497.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC GENE FULL SEQUENCE", "code_information": [{"code": "81201", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2333.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4685.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 4685.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4932.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 4439.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF 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"AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 819.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 696.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC MRNA SEQ ALYS", "code_information": [{"code": "157U", "type": "CPT"}], "standard_charges": [{"minimum": 704.04, "maximum": 828.33, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 828.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 704.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHAGRAFT CELLULAR BONE MATRIX 10CC 210-100 APHAGRAFT", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "210-100 APHAGRAFT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10088.0, "discounted_cash": 6052.8, "setting": "both", "billing_class": "facility"}]}, {"description": "APHAKIA PROSTH SERVICE TEMP", "code_information": [{"code": "92358", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHERESIS IMMUNOADS SLCTV", "code_information": [{"code": "36516", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHERESIS PLASMA", "code_information": [{"code": "36514", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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"plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHERESIS PLATELETS", "code_information": [{"code": "36513", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHERESIS RBC", "code_information": [{"code": "36512", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHERESIS WBC", "code_information": [{"code": "36511", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": 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2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APOLLO MEDIAL WITH 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"standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP. 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "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": 1483.0, "maximum": 18989.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "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": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE 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"standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO FEMORAL", "code_information": [{"code": "20663", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO PELVIC", "code_information": [{"code": "20662", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION INTERVERTERAL DEVICE 22851", "code_information": [{"code": "22851", "type": "CPT"}, {"code": "1479958", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29000", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29010", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29015", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF CLUBFOOT CAST 29450", "code_information": [{"code": "29450", "type": "CPT"}, {"code": "1479959", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 45.65, "maximum": 8427.0, "gross_charge": 83.0, "discounted_cash": 49.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 45.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST", "code_information": [{"code": "29365", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST BRACE 29358", "code_information": [{"code": "29358", "type": "CPT"}, {"code": "1479960", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 34.65, "maximum": 8427.0, "gross_charge": 63.0, "discounted_cash": 37.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 34.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee 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"standard_charges": [{"minimum": 34.65, "maximum": 8427.0, "gross_charge": 63.0, "discounted_cash": 37.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 34.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF MULTI-LAYER COMPRESSION SYSTEM; LEG 29581", "code_information": [{"code": "29581", "type": "CPT"}, {"code": "44906278", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 224.0, "discounted_cash": 134.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF MULTIPLANE UNILATERAL EXT. 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"standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF PASTE BOOT", "code_information": [{"code": "29580", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF RIGID TOTAL CONTACT LEG CAST 29445", "code_information": [{"code": "29445", "type": "CPT"}, {"code": "1479963", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 41.25, "maximum": 8427.0, "gross_charge": 75.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF UNIPLANE UNILATERAL EXT. 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[{"code": "29105", "type": "CPT"}, {"code": "1479974", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 19.8, "maximum": 9519.0, "gross_charge": 36.0, "discounted_cash": 21.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 19.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATON ON-BODY INJECTOR", "code_information": [{"code": "96377", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATOR 360 FLEXTIP 40CM", "code_information": [{"code": "SA3768111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 367.5, "discounted_cash": 220.5, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR ARISTA 14 CM EXTENDED ENT SURGERY FLEXITIP", "code_information": [{"code": "AM0004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.4, "discounted_cash": 46.44, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLORHEXIDINE GLUCONATE 10.5 ML ORANGE SKIN PREP CHLORAPREP LF", "code_information": [{"code": "260715", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.29, "discounted_cash": 14.57, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLORHEXIDINE GLUCONATE 26 ML ORANGE SKIN PREP CHLORAPREP LF", "code_information": [{"code": "260815", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.32, "discounted_cash": 19.39, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLRPRP ORNG TNTD 10.5ML 930715", "code_information": [{"code": "930715", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.68, "discounted_cash": 11.81, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR COTTON-TIP WOOD 6 STERIL MDS202000", "code_information": [{"code": "MDS202000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.06, "discounted_cash": 0.04, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR DUPLOSPRAY MIS 40CM", "code_information": [{"code": "601130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 273.16, "discounted_cash": 163.9, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR EXTENDED VITAGEL MALLEABLE", "code_information": [{"code": "2113-0002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 191.25, "discounted_cash": 114.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR EXTENDID TIP 5.1MM X 8MM", "code_information": [{"code": "205108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 191.36, "discounted_cash": 114.82, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR FLOSEAL ENDOSCOPIC", "code_information": [{"code": "600125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 145.6, "discounted_cash": 87.36, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR SLNT 35MM FIBRIN EXTD W/ 2 RADIOPAQUE REPLACE SPRAY TIPS DUROPLEACH 3", "code_information": [{"code": "921050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 183.8, "discounted_cash": 110.28, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR SPRAYERDURASEAL MICROMYST 15CM", "code_information": [{"code": "20-5000DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 635.31, "discounted_cash": 381.19, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR SURG 38CM XL ABSORBL HEMOSTATIC PARTICLES ARISTA FLEXITIP", "code_information": [{"code": "AM0005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.56, "discounted_cash": 49.54, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR SURGICEL ENDOSCOPIC 3123SPEA", "code_information": [{"code": "3123SPEA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.3, "discounted_cash": 54.18, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR TIP EXTENDED DURASEAL", "code_information": [{"code": "20-5108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.95, "discounted_cash": 288.57, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIED 12X150 NON BLADE", "code_information": [{"code": "CFF71", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 227.84, "discounted_cash": 136.7, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP 11.5IN MED PREMIUM SURGICLIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "134053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.43, "discounted_cash": 296.66, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP 11.5IN SM PREMIUM SURGICLIP DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "134031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.43, "discounted_cash": 296.66, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP 5MM MULTIPLE ENDO ROTATING LF STRL DISP", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "ETHEL5ML", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 428.45, "discounted_cash": 257.07, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP 9.75IN MD PREMIUM SURGICLIP II SUPER INTERLOCK BLUE", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "134051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 463.14, "discounted_cash": 277.88, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP 9IN SM PREMIUM SURGICLIP", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "134046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 595.09, "discounted_cash": 357.05, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP ENDO 5MM EL5ML", "code_information": [{"code": "EL5ML", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 467.92, "discounted_cash": 280.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP ENDO CLIP II 10MM TITANIUM 176657", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "176657", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 548.15, "discounted_cash": 328.89, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP LIGACLIP 20SMALL 9 3/8 MCS20", "code_information": [{"code": "MCS20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 189.6, "discounted_cash": 113.76, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP LIGACLIP MD/LG STERILE ER320", "code_information": [{"code": "ER320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 405.33, "discounted_cash": 243.2, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP LIGACLIP MULTI 20LARGE 13 MCL20", "code_information": [{"code": "MCL20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 145.18, "discounted_cash": 87.11, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP LIGACLIP MULTI 20MD 11 MCM20", "code_information": [{"code": "MCM20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 415.7, "discounted_cash": 249.42, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP LIGACLIP MULTI 20MD 9 3/8 MSM20", "code_information": [{"code": "MSM20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.83, "discounted_cash": 11.3, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP MEDIUM-LARGE  X/XI 5MM DAVINCI", "code_information": [{"code": "478053", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3456.0, "discounted_cash": 2073.6, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP SM 9.375IN MULTIPLE W/ TWENTY CLIP LIGACLIP", "code_information": [{"code": "MSC20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 199.73, "discounted_cash": 119.84, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP SURGICLIP L-13.0 AUTO G 134048", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "134048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 595.09, "discounted_cash": 357.05, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP WECK HEM-O-LOK ENDO10 LIGATING LARGE 12 1/2IN 10MM 544995", "code_information": [{"code": "544995", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2055.97, "discounted_cash": 1233.58, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP WECK HEM-O-LOK ENDO5 LIGATING MEDIUM-LARGE 12 3/4IN 5MM 544965", "code_information": [{"code": "544965", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2055.97, "discounted_cash": 1233.58, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT COMPL", "code_information": [{"code": "77763", "type": "CPT"}], "standard_charges": [{"minimum": 685.18, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 685.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1376.16, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 970.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3159.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2685.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT INTERM", "code_information": [{"code": "77762", "type": "CPT"}], "standard_charges": [{"minimum": 2129.92, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2696.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5415.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 5415.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 5700.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5130.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 3819.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2505.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2129.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT SIMPLE", "code_information": [{"code": "77761", "type": "CPT"}], "standard_charges": [{"minimum": 493.25, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for 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"standard_charge_dollar": 990.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 990.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1042.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 938.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 698.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2505.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2129.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY R&L PULM ART BANDS", "code_information": [{"code": "33620", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29405", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY SRS HEADFRAME ADD-ON", "code_information": [{"code": "61800", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY SURF LDR RADIONUCLIDE", "code_information": [{"code": "77789", "type": "CPT"}], "standard_charges": [{"minimum": 65.96, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 132.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 132.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 139.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 125.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 93.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 535.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 455.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APS RETRACTOR 16.6CM x 16.2CM COOPER SURG", "code_information": [{"code": "3715", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 142.2, "setting": "both", "billing_class": "facility"}]}, {"description": "AQAPRN-4 ANTB FLO CYTMTRY EA", "code_information": [{"code": "86053", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 376.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 755.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 755.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 795.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 715.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 532.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 110.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 93.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQMBF PET REST & RX STRESS", "code_information": [{"code": "78434", "type": "CPT"}], "standard_charges": [{"minimum": 99.23, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 99.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 199.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 199.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 209.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 188.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 140.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee 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DISTAL FEMUR 27475", "code_information": [{"code": "27475", "type": "CPT"}, {"code": "1479976", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-AXILLARY", "code_information": [{"code": "35650", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-FEMORAL", "code_information": [{"code": "35621", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-POP-TIBIAL", "code_information": [{"code": "35623", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP CAROTID-SUBCLAVIAN", "code_information": [{"code": "35606", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP CAROTID-VERTEBRAL", "code_information": [{"code": "35642", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP COMMON IPSI CAROTID", "code_information": [{"code": "35601", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP FEM-ANT-POST TIB/PRL", "code_information": [{"code": "35566", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP FEM-ANT-POST TIB/PRL", "code_information": [{"code": "35666", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP FEMORAL-FEMORAL", "code_information": [{"code": "35661", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP FEMORAL-POPLITEAL", "code_information": [{"code": "35656", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AOR/CAROT/INNOM", "code_information": [{"code": "35526", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORCEL/AORMESEN", "code_information": [{"code": "35531", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTBIFEMORAL", "code_information": [{"code": "35540", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOBI-ILIAC", "code_information": [{"code": "35538", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOFEMORAL", "code_information": [{"code": "35539", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOILIAC", "code_information": [{"code": "35537", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTORENAL", "code_information": [{"code": "35560", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL-BRACHIAL", "code_information": [{"code": "35522", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL-FEMORAL", "code_information": [{"code": "35521", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL/FEM/FEM", "code_information": [{"code": "35533", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILLARY-AXILRY", "code_information": [{"code": "35518", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT BRACHIAL-BRCHL", "code_information": [{"code": "35525", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT BRCHL-ULNR-RDL", "code_information": [{"code": "35523", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CAROTID-BRCHIAL", "code_information": [{"code": "35510", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CAROTID-VERTBRL", "code_information": [{"code": "35508", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CONTRAL CAROTID", "code_information": [{"code": "35509", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT FEM-FEMORAL", "code_information": [{"code": "35558", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT FEM-POPLITEAL", "code_information": [{"code": "35556", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT HEPATORENAL", "code_information": [{"code": "35535", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT ILIOFEMORAL", "code_information": [{"code": "35565", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT ILIOILIAC", "code_information": [{"code": "35563", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT IPSILAT CAROTID", "code_information": [{"code": "35501", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SPLENORENAL", "code_information": [{"code": "35536", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-AXILARY", "code_information": [{"code": "35516", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-BRCHIAL", "code_information": [{"code": "35512", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-CAROTID", "code_information": [{"code": "35506", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-SUBCLAV", "code_information": [{"code": "35511", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-VERTBRL", "code_information": [{"code": "35515", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIO-CELIAC", "code_information": [{"code": "35632", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIO-MESENTERIC", "code_information": [{"code": "35633", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIOFEMORAL", "code_information": [{"code": "35665", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIOILIAC", "code_information": [{"code": "35663", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIORENAL", "code_information": [{"code": "35634", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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"standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP POP-TIBL-PRL-OTHER", "code_information": [{"code": "35571", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP POP-TIBL-PRL-OTHER", "code_information": [{"code": "35671", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP SPENORENAL", "code_information": [{"code": "35636", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-AXILLARY", "code_information": [{"code": "35616", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-SUBCLAVIAN", "code_information": [{"code": "35612", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-VERTEBRL", "code_information": [{"code": "35645", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP TIBIAL-TIB/PERONEAL", "code_information": [{"code": "35570", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART PRESSURE WAVEFORM ANALYS", "code_information": [{"code": "93050", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ CAROTID SUBCLAV", "code_information": [{"code": "35695", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ SUBCLAV CAROTID", "code_information": [{"code": "35694", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ SUBCLAVIAN", "code_information": [{"code": "35693", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ VERTBRL CAROTID", "code_information": [{"code": "35691", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY EXPOS/GRAFT ARTERY", "code_information": [{"code": "33987", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY TO VEIN SHUNT", "code_information": [{"code": "36835", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY TRANSPOSE/ENDOVAS TAA", "code_information": [{"code": "33889", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAY EACH VESSEL", "code_information": [{"code": "75774", "type": "CPT"}], "standard_charges": [{"minimum": 838.38, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 838.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1683.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1683.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1772.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1595.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1187.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ABDOMEN", "code_information": [{"code": "75726", "type": "CPT"}], "standard_charges": [{"minimum": 1001.26, "maximum": 22498.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1001.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2010.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2010.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2116.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1905.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1418.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 22498.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 19122.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ADRENAL GLAND", "code_information": [{"code": "75731", "type": "CPT"}], "standard_charges": [{"minimum": 862.65, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 862.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1732.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1732.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1823.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1641.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1221.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ADRENALS", "code_information": [{"code": "75733", "type": "CPT"}], "standard_charges": [{"minimum": 1171.38, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1171.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2352.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2352.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2476.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2228.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1659.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ARM/LEG", "code_information": [{"code": "75710", "type": "CPT"}], "standard_charges": [{"minimum": 978.58, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 978.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1965.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1965.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2068.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1861.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1386.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ARMS/LEGS", "code_information": [{"code": "75716", "type": "CPT"}], "standard_charges": [{"minimum": 950.19, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 950.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1908.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1908.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2008.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1808.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1345.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS CHEST", "code_information": [{"code": "75756", "type": "CPT"}], "standard_charges": [{"minimum": 962.44, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 962.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1933.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1933.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2034.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1831.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1363.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS LUNG", "code_information": [{"code": "75741", "type": "CPT"}], "standard_charges": [{"minimum": 846.99, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 846.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1701.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1701.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1790.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1611.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1199.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS LUNG", "code_information": [{"code": "75746", "type": "CPT"}], "standard_charges": [{"minimum": 989.27, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 989.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1986.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1986.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2091.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1882.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1401.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS LUNGS", "code_information": [{"code": "75743", "type": "CPT"}], "standard_charges": [{"minimum": 1172.8, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1172.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2355.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2355.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2479.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2231.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1661.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS PELVIS", "code_information": [{"code": "75736", "type": "CPT"}], "standard_charges": [{"minimum": 575.31, "maximum": 22498.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 575.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1155.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1155.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1216.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1094.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 814.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 22498.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 19122.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS SPINE", "code_information": [{"code": "75705", "type": "CPT"}], "standard_charges": [{"minimum": 969.38, "maximum": 22498.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 969.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1946.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1946.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2049.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1844.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1373.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 22498.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 19122.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY-VEIN AUTOGRAFT", "code_information": [{"code": "36825", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY-VEIN NONAUTOGRAFT", "code_information": [{"code": "36830", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 9519.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHODESIS SACROILIAC JOINT INC. GRAFT/ INST. 27280", "code_information": [{"code": "27280", "type": "CPT"}, {"code": "2034629", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT DFRM 8+ VRT SGM", "code_information": [{"code": "22812", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT TORAL/XORAL C1-C2", "code_information": [{"code": "22548", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF 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combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM 13+ VRT SGM", "code_information": [{"code": "22804", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM 7-12 VRT SGM", "code_information": [{"code": "22802", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for 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"plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRO, LOOSE BODY + CHONDRO", "code_information": [{"code": "G0289", "type": "HCPCS"}], "standard_charges": [{"minimum": 1105.0, "maximum": 6541.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROCENTESIS ASPIRATION AND/OR INJECTION SMALL JT OR BURSA W/ULTRASOUND 20604", "code_information": [{"code": "20604", "type": "CPT"}, {"code": "38612797", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 18989.0, "gross_charge": 3525.0, "discounted_cash": 2115.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1938.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROCENTESIS SMALL JOINT OR BURSA; W/O ULTRASOUND GUIDANCE 20600", "code_information": [{"code": "20600", "type": "CPT"}, {"code": "1479979", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASCENDING AORTIC GRAFT", "code_information": [{"code": "33864", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": 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[{"code": "476101000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 667.66, "discounted_cash": 400.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ASHKENAZI JEWISH ASSOC DIS", "code_information": [{"code": "81412", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 292.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 588.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 588.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 619.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 557.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 414.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7169.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 6094.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPA GENE", "code_information": [{"code": "81200", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee 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"standard_charge_dollar": 135.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 142.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 128.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 95.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 138.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 117.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPERGILLUS AG IA", "code_information": [{"code": "87305", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 83.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 168.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 168.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 177.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 159.47, "methodology": "fee schedule"}, {"payer_name": "BLUE 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 116.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 116.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 122.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 110.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 81.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 44.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 37.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIR/INJ THYROID CYST", "code_information": [{"code": "60300", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIRATE PLEURA W/ IMAGING", "code_information": [{"code": "32555", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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"standard_charge_dollar": 46.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 39.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATOMIZER LARYNG-TRACH DEVICE SYRINGE 3ML", "code_information": [{"code": "MAD600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.28, "discounted_cash": 32.57, "setting": "both", "billing_class": "facility"}]}, {"description": "ATROPINE 1% 3.5 GM OPTH OINTMENT", "code_information": [{"code": "MED0011", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 83.05, "discounted_cash": 49.83, "setting": "both", "billing_class": "facility"}]}, {"description": "ATROPINE SULFATE 1% OPHTHALMIC SOLUTION 2ML", "code_information": [{"code": "MED0568", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 95.29, "discounted_cash": 57.17, "setting": "both", 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTACHMENT  902-323 18MM S B REMOVER 902-323", "code_information": [{"code": "902-323", "type": "CDM"}], "standard_charges": [{"gross_charge": 2001.13, 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[{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTEMPTED VBAC DELIVERY", "code_information": [{"code": "59618", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], 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"discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AUGMENT TIBL SZ 3 10MM TRIATHLON LL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5546-A-302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2562.56, "discounted_cash": 1537.54, "setting": "both", "billing_class": "facility"}]}, {"description": "AUGMENT TIBL SZ 3 10MM TRIATHLON RL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5546-A-301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2562.56, "discounted_cash": 1537.54, "setting": "both", "billing_class": "facility"}]}, {"description": "AUGMENT WING SM CRUCIATE TIBL VANGUARD 360 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "185650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2626.4, "discounted_cash": 1575.84, "setting": "both", "billing_class": "facility"}]}, {"description": "AUGMENTATION CHEEK BONE", "code_information": [{"code": "21270", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, 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"UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION GENIOPLASTY SINGLE CHIN 21121", "code_information": [{"code": "21121", "type": "CPT"}, {"code": "1480138", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8536.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION LOWER JAW BONE", "code_information": [{"code": "21125", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION LOWER JAW BONE", "code_information": [{"code": "21127", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUGMENTED REAMER GUIDE BUSHING", "code_information": [{"code": "110031869", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 186.44, "discounted_cash": 111.86, "setting": "both", "billing_class": "facility"}]}, {"description": "AUGMENTED REAMER GUIDE SCREW", "code_information": [{"code": "110040300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 186.44, "discounted_cash": 111.86, "setting": "both", "billing_class": "facility"}]}, {"description": "AUTO ALYS XST CT STD VRT FX", "code_information": [{"code": "691T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTO QUAN C PLAQ DATA PREP", "code_information": [{"code": "624T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 4173.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTO QUAN C PLAQ 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for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTO QUANTIFICATION C PLAQUE", "code_information": [{"code": "623T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee 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"AUTOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL BICORTICAL OR TIRCORTICAL 20938", "code_information": [{"code": "20938", "type": "CPT"}, {"code": "2334787", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.7, "maximum": 18989.0, "gross_charge": 1534.0, "discounted_cash": 920.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, 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schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1474.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1474.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1552.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1396.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1039.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 11.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 10.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOLOGOUS BLOOD PROCESS", "code_information": [{"code": "86890", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 259.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 520.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 520.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 547.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 492.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 367.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC", "code_information": [{"code": "16", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 54.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 59.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 44.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "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": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC", "code_information": [{"code": "17", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 54.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 59.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 44.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "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": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTOLOGOUS TISSUE COLLECTOR", "code_information": [{"code": "ABS-1050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1386.72, "discounted_cash": 832.03, "setting": "both", "billing_class": "facility"}]}, {"description": "AUTOMATED DIFF WBC COUNT", "code_information": [{"code": "85004", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 74.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 74.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 78.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 70.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 52.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 18.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 16.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOMATED RBC COUNT", "code_information": [{"code": "85041", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 35.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 35.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 37.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 33.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 25.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTONOMIC NRV ADRENRG INERVJ", "code_information": [{"code": "95922", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTONOMIC NRV PARASYM INERVJ", "code_information": [{"code": "95921", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTONOMIC NRV SYST FUNJ TEST", "code_information": [{"code": "95923", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88020", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 558.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1122.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1122.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1181.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1062.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 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"plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4730.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 4730.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4979.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", 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"methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AV FISTULA REVISION OPEN", 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"standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AV FUSE UPPR ARM BASILIC", "code_information": [{"code": "36819", "type": "CPT"}], "standard_charges": [{"minimum": 3869.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AV FUSION DIRECT ANY SITE", "code_information": [{"code": "36821", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 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"billing_class": "facility"}]}, {"description": "Amantadine hcl 100mg oral", "code_information": [{"code": "G9017", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC MEDICARE ADV", "standard_charge_dollar": 350.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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": "Ambulance, Medical Transport", "code_information": [{"code": "542", "type": "RC"}], "standard_charges": [{"minimum": 350.0, "maximum": 350.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "additional_payer_notes": "No historical data found 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[{"code": "547T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "B1 STR & FX RSK ANALYSIS", "code_information": [{"code": "554T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "B1 STR & FX RSK ASSESSMENT", "code_information": [{"code": "556T", "type": "CPT"}], "standard_charges": [{"minimum": 874.31, "maximum": 1028.67, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1028.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 874.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "B1 STR & FX RSK VRT FX ASSMT", "code_information": [{"code": "743T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "B1 STR&FX RSK ASMT DXRBMD1VW", "code_information": [{"code": "750T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "B1 STR&FX RSK ASSMT DXR-BMD", "code_information": [{"code": "749T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "B1 STR&FX RSK TRANSMIS DATA", "code_information": [{"code": "555T", "type": "CPT"}], "standard_charges": [{"minimum": 93.89, "maximum": 110.46, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 110.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 93.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BABCOCK ENDOPATH HANDLE 10MM -ORDR QTY 6 10BB", "code_information": [{"code": "10BB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.11, "discounted_cash": 120.07, "setting": "both", "billing_class": "facility"}]}, {"description": "BABESIA MICROTI AMP PRB", "code_information": [{"code": "87469", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 77.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 154.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 154.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 162.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 146.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 109.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 102.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 87.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BACI/NEO/POLY(NEOSPORIN  OPHTH) 3.5GM", "code_information": [{"code": "MED0017", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 50.63, "discounted_cash": 30.38, "setting": "both", "billing_class": "facility"}]}, {"description": "BACI/NEO/POLY(NEOSPORIN) OINTMENT FOIL PACK UD", "code_information": [{"code": "MED0018", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.77, "discounted_cash": 0.46, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN 500 UNITS/G OINTMENT 15GM", "code_information": [{"code": "MED0015", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.82, "discounted_cash": 4.69, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN OPHTHALMIC OINTMENT 500U/GM 3.5 GM", "code_information": [{"code": "MED0016", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 279.16, "discounted_cash": 167.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN STERILE 50,000 UNIT VIAL", "code_information": [{"code": "MED0019", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 26.35, "discounted_cash": 15.81, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN TOP 500 UNITS/G OINT UD 0.9 GM", "code_information": [{"code": "MED0014", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.65, "discounted_cash": 0.39, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN TOPICAL ZINC 500 UNITS/G/m OINT 30 GM", "code_information": [{"code": "MED0832", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 6.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN ZINC OINTMENT 30 GM TUBE", "code_information": [{"code": "MED0865", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.66, "discounted_cash": 5.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN ZINC OINTMENT PACKET 500U 0.9GM", "code_information": [{"code": "MED0021", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.76, "discounted_cash": 0.46, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN ZINC/POLYMYXIN B OINTMENT 0.9 GM FOIL PACKET", "code_information": [{"code": "MED0022", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.34, "discounted_cash": 0.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN-POLYMYXIN B TOP OINTMENT 15 GM", "code_information": [{"code": "MED0020", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 24.86, "discounted_cash": 14.92, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN/NEOMYCIN/POLYMYXIN B TOP OINT (NEOSPORIN) 30 GM", "code_information": [{"code": "MED0829", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.51, "discounted_cash": 6.31, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN/POLYMYXIN (POLYSPORIN) 3.5GM OPHTHALMIC OINTMENT", "code_information": [{"code": "MED0023", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 62.68, "discounted_cash": 37.61, "setting": "both", "billing_class": "facility"}]}, {"description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [{"code": "519", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4699.0, "maximum": 35308.0, "estimated_discounted_cash": 22329.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 22365.29, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 18268.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 29079.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 14942.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 24717.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 35308.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13667.08, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 4699.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR", "code_information": [{"code": "518", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4699.0, "maximum": 40649.73, "estimated_discounted_cash": 27954.95, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 40649.73, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 18268.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 29079.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 14942.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 24717.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 35308.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 22755.47, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 4699.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC", "code_information": [{"code": "520", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4699.0, "maximum": 35308.0, "estimated_discounted_cash": 26842.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 16255.35, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 18268.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 29079.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 14942.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 24717.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 35308.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", 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"W035-DB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.12, "discounted_cash": 25.87, "setting": "both", "billing_class": "facility"}]}, {"description": "BALL PIN .035IN WHT W SERIES REFILL PIN BALLS", "code_information": [{"code": "W035-WH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.67, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BALL PIN .045IN 1.1MM YELLOW FOR KIRSCHNER WIRE W SERIES", "code_information": [{"code": "W045-YL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.25, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BALL PIN .062IN 1.6MM GRN FOR KIRSCHNER WIRE W SERIES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "W062-GN", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 39.01, "discounted_cash": 23.41, "setting": "both", "billing_class": "facility"}]}, {"description": "BALL PIN 3/32IN CREAM FOR KIRSCHNER WIRE W SERIES", "code_information": [{"code": "W332-CR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.67, "discounted_cash": 19.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BALL PIN 5/64IN LIGHT BLUE FOR KIRSCHNER WIRE W SERIES", "code_information": [{"code": "W564-BL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.25, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLON DIALATOR UROMAX ULTRA HIGH PRESSURE 15FR X 10CM", "code_information": [{"code": "M0062251160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 608.55, "discounted_cash": 365.13, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLON NASAL NUVENT 70D FRONTAL 6 X 17MM", 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"discounted_cash": 3013.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON AVAFLEX 11G 30MM CURVED", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "1031-130-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6506.5, "discounted_cash": 3903.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON AVAMAX 13G 15MM", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "1021315000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3640.0, "discounted_cash": 2184.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON CATHETER ZVPLASTY 10G KYPHOPLASTY KIT WITH 15MM  VCF-1015-2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "VCF-1015-2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8572.2, "discounted_cash": 5143.32, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON DILATE URTRL STRIX", "code_information": [{"code": "50706", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", 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7140.42, "discounted_cash": 4284.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 11.0MM SZ 4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-411", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4730.44, "discounted_cash": 2838.26, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 11MM X 71/75MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EP-183641", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7446.4, "discounted_cash": 4467.84, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 11MM X79/83MM CRUCIATE RETAINING LIPPED VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EP-183561", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7293.0, "discounted_cash": 4375.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 12MM VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EP-183662", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7415.2, "discounted_cash": 4449.12, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 12MM X 71/75MM CRUCIATE RETAINING LIPPED VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EP-183542", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7140.42, "discounted_cash": 4284.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 12MM X 71/75MM POST STABILISED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EP-183642", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7446.4, "discounted_cash": 4467.84, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 12MM X 71MM ANT STABILISED VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EP-189062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4915.3, "discounted_cash": 2949.18, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 14MM X 63/67MM POST STABILISED VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EP-183624", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4867.2, "discounted_cash": 2920.32, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 14MM X 63MM ANT STABILISED VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EP-189024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7051.2, "discounted_cash": 4230.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 14MM X 71/75MM POST 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"EP-183622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6943.09, "discounted_cash": 4165.85, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 71/75 X 10MM MODULAR CRUCIATE RETAINING COMPLETE KNEE SYS VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EP-183440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7293.0, "discounted_cash": 4375.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 71/75 X 11MM MODULAR CRUCIATE RETAINING COMPLETE KNEE SYS VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EP-183441", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5610.0, "discounted_cash": 3366.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 71/75 X 12MM MODULAR CRUCIATE RETAINING COMPLETE KNEE SYS VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EP-183442", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7293.0, "discounted_cash": 4375.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 71MM X 75MM X 12MM CRUCIATE RETAINING MODULAR VANGUARD IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "183442", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3705.0, "discounted_cash": 2223.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 79/83 X 12MM MODULAR CRUCIATE RETAINING COMPLETE KNEE SYS VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EP-183462", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7140.42, "discounted_cash": 4284.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 79MM X 83/10MM VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EP-183460", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7293.0, "discounted_cash": 4375.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 79MM X 83/11MM VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "EP-183461", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7293.0, "discounted_cash": 4375.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL 9.0MM SZ 4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4645.47, "discounted_cash": 2787.28, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL SZ 3 10MM IBALANCE UKA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-501-TBC0", "type": 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[{"gross_charge": 2250.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL SZ 3 SM RIGHT ANATOMIC OXFORD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "159568", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3770.0, "discounted_cash": 2262.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL SZ 4 EXTRA SM RIGHT ANATOMIC OXFORD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "160791", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3770.0, "discounted_cash": 2262.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL SZ 4 LG ANATOMIC LFT OXFORD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "159555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3770.0, "discounted_cash": 2262.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL SZ 4 SM RIGHT ANATOMIC OXFORD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "159569", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2954.83, "discounted_cash": 1772.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL SZ 5 9MM IBALANCE UKA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-501-TBE9", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL SZ 5 EXTRA SM LFT ANATOMIC OXFORD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "159792", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3770.0, "discounted_cash": 2262.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL SZ 5 SM RIGHT ANATOMIC OXFORD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "159570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3770.0, "discounted_cash": 2262.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL SZ 6 SM ANATOMIC LFT OXFORD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "159543", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3770.0, "discounted_cash": 2262.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL SZ 6 SM RIGHT ANATOMIC OXFORD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "159571", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3770.0, "discounted_cash": 2262.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL SZ 7 LG RIGHT ANATOMIC OXFORD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "159586", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3770.0, "discounted_cash": 2262.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBL SZ 8 MED RIGHT ANATOMIC OXFORD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "159580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3770.0, "discounted_cash": 2262.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING VANGUARD KNEE VIVACIT-E TIBIAL LIPPED CRUCIATE RETAINING 71/75MM WIDTH 16MM THICK VE183546", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "VE183546", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1575.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING VGD VE PS TIB BRG 71/75X12MM VE183642", "code_information": [{"code": "C1776", "type": 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"discounted_cash": 110.96, "setting": "both", "billing_class": "facility"}]}, {"description": "BIFURCATED LIGHT SOURCE", "code_information": [{"code": "GZA160002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1166.4, "discounted_cash": 699.84, "setting": "both", "billing_class": "facility"}]}, {"description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [{"code": "461", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3870.0, "maximum": 67947.65, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 67947.65, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 4732.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7533.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 3870.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 6403.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 9144.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 32901.55, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", 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7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILATERAL 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": 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"payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 217.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 437.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", 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"standard_charge_dollar": 308.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 77.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 66.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILE ACIDS TOTAL", "code_information": [{"code": "82239", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 60.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 122.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 122.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 128.82, "methodology": "fee schedule"}, {"payer_name": "BLUE 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILE DUCT REVISION", "code_information": [{"code": "47701", 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OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDO PERQ DX W/SPECI", "code_information": [{"code": "47552", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47553", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": 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"standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee 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WITH MCC", "code_information": [{"code": "408", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29701.31, "maximum": 39711.74, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 39711.74, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 29701.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. 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0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 27.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 56.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 56.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"code_information": [{"code": "88720", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 33.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 33.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 31.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 23.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 14.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILOBECTOMY", "code_information": [{"code": "32482", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": 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DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EYELID 67810", "code_information": [{"code": "67810", "type": "CPT"}, {"code": "1480166", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FLOOR OF MOUTH 41108", "code_information": [{"code": "41108", "type": "CPT"}, {"code": "3532519", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FOOT JOINT LINING", "code_information": [{"code": "28050", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FOOT JOINT LINING", "code_information": [{"code": "28052", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF HEART LINING", "code_information": [{"code": "93505", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH 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"27052", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO 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5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF LACRIMAL GLAND 68510", "code_information": [{"code": "68510", "type": "CPT"}, {"code": "1480167", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SOFT TISSUES", "code_information": [{"code": "27040", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", 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"standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TESTIS INCISIONAL 54505", "code_information": [{"code": "54505", "type": "CPT"}, {"code": "1480171", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, 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{"description": "BIT DRILL 1.8MM Y-KNOT", "code_information": [{"code": "Y180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 164.74, "discounted_cash": 98.84, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.9MM", "code_information": [{"code": "MFT-072-19", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.28, "discounted_cash": 252.17, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.9MM X 40MM", "code_information": [{"code": "INS-114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 760.76, "discounted_cash": 456.46, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRILL 1.9MM X 5.5MM CENTERPIECE STERILE INSTRUMENT DISPOSABLE", "code_information": [{"code": "8530605", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 298.19, "discounted_cash": 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[{"gross_charge": 181.46, "discounted_cash": 108.88, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRLL 2MM 140/115MM 3 FLUTE QUICK COUPLING W/ DOUBLE DEPTH MARKINGINSTR", "code_information": [{"code": "323.062", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 508.8, "discounted_cash": 305.28, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRLL 3.0MM X 6-18MM CORT RECONSTRUCTION SYS VERTEX MAX STRL DISP", "code_information": [{"code": "6956012", "type": "CDM"}], "standard_charges": [{"gross_charge": 468.63, "discounted_cash": 281.18, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRLL 8MM CANN KNEE FOR ACL CRUIATE RECONSTRUCTION TOOLBOX SETINSTR", "code_information": [{"code": "AR-1208L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 446.88, "discounted_cash": 268.13, "setting": "both", "billing_class": "facility"}]}, {"description": 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110MM 698.524", "code_information": [{"code": "698.524", "type": "CDM"}], "standard_charges": [{"gross_charge": 1127.84, "discounted_cash": 676.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE  CC  120MM 698.526", "code_information": [{"code": "698.526", "type": "CDM"}], "standard_charges": [{"gross_charge": 1127.84, "discounted_cash": 676.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE  CC  130MM 698.528", "code_information": [{"code": "698.528", "type": "CDM"}], "standard_charges": [{"gross_charge": 1127.84, "discounted_cash": 676.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE  CC  140MM 698.53", "code_information": [{"code": "698.53", "type": "CDM"}], "standard_charges": [{"gross_charge": 1127.84, "discounted_cash": 676.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE  CC  150MM 698.532", "code_information": [{"code": "698.532", "type": "CDM"}], "standard_charges": 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{"description": "BLADE 90.0 MM X 12.7 MM X 1.26 MM SAGITTAL 5801-4105", "code_information": [{"code": "5801-4105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 586.53, "discounted_cash": 351.92, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE 90X25MM 1.14MM MAT THK 1.27MM BR4125-127-090", "code_information": [{"code": "BR4125-127-090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.84, "discounted_cash": 59.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE 9563002 MIDLINE HANDLE 9563002", "code_information": [{"code": "9563002", "type": "CDM"}], "standard_charges": [{"gross_charge": 907.73, "discounted_cash": 544.64, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE 9563060 MIDLINE BLADE LEFT 4 9563060", "code_information": [{"code": "9563060", "type": "CDM"}], "standard_charges": [{"gross_charge": 1436.4, "discounted_cash": 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SAMURAIINSTR", "code_information": [{"code": "CAT00227", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 553.95, "discounted_cash": 332.37, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG MED 31MM X 9MM LNG STRL DISP", "code_information": [{"code": "2296-003-125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.27, "discounted_cash": 72.16, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG MINI 180 DEGREE CUTTING SURFACE BEVEL BLADE BEAVER 6900", "code_information": [{"code": "BEAVER6900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.41, "discounted_cash": 26.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG OPHTHALMIC MINI 11 STRAIGHT STRL", "code_information": [{"code": "376500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.17, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG OPTHALMIC MICROSCLEROTOMY SHARP ALL AROUND HOCKEY STICK SLOTTED TIP S", "code_information": [{"code": "8065005701", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.96, "discounted_cash": 32.38, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURG TYMPANOPLASTY PRECISE KLIGEN SS STRLINSTR DISP", "code_information": [{"code": "8000140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.79, "discounted_cash": 39.47, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURGEONS SS 15C STERILE 371716", "code_information": [{"code": "371716", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.38, "discounted_cash": 3.83, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURGICAL CLIPPER PREPARATION STANDARD DISP", "code_information": [{"code": "PH-2602-3", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.58, "discounted_cash": 6.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURGICAL QUADCUT FOR STRAIGHTSHOT M4", "code_information": [{"code": "1884380HR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 587.96, "discounted_cash": 352.78, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SURGICAL SZ 11", "code_information": [{"code": "D2862-11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.69, "discounted_cash": 3.41, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TENDON STRIPPER 9MM ACL RECONSTRUCTION", "code_information": [{"code": "AR-2385-09", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 776.72, "discounted_cash": 466.03, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TREPHINE 10.5MM CORNEALINSTR", "code_information": [{"code": "9550006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.5, "discounted_cash": 96.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TREPHINE 10MM STRL DISP", "code_information": [{"code": "9721", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.5, "discounted_cash": 96.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TREPHINE 11.5MM CORNEALINSTR", "code_information": [{"code": "9550013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.5, "discounted_cash": 96.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TREPHINE 11MM CORNEALINSTR", "code_information": [{"code": "9725", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.5, "discounted_cash": 96.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TREPHINE 12MM CORNEALINSTR", "code_information": [{"code": "9550028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 102.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TREPHINE 13MM CORNEALINSTR", "code_information": [{"code": "9550029", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 102.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TREPHINE 14MM CORNEALINSTR", "code_information": [{"code": "9728", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 102.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TREPHINE 14MM ID X 8IN", "code_information": [{"code": "270905140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1114.56, "discounted_cash": 668.74, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TREPHINE 16MM ID X 8IN", "code_information": [{"code": "270905160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1114.56, "discounted_cash": 668.74, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TREPHINE 17MM ID X 8IN", "code_information": [{"code": "270905170", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1114.56, "discounted_cash": 668.74, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TREPHINE 5.5MM CORNEAL SSINSTR", "code_information": [{"code": "9703", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.5, "discounted_cash": 96.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TREPHINE 5MM CORNEAL SSINSTR", "code_information": [{"code": "9701", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.5, "discounted_cash": 96.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TREPHINE 6.5MM CORNEALINSTR", "code_information": [{"code": "9707", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.5, "discounted_cash": 96.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TREPHINE 6MM CORNEALINSTR", "code_information": [{"code": "9705", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.5, "discounted_cash": 96.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TREPHINE 7MM STRL DISP", "code_information": [{"code": "9709", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.5, "discounted_cash": 96.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TRICUT ANGLED TIP 22.5CM X 4MM", "code_information": [{"code": "1884030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1097.39, "discounted_cash": 658.43, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TRICUT ANGLED TIP 27.5CM X 4MM", "code_information": [{"code": "1884031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1059.64, "discounted_cash": 635.78, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TRICUT LARYNGEAL SHAVER", "code_information": [{"code": "1884030HRE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1235.84, "discounted_cash": 741.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TRUCLEAR INCISOR PLUS 2.9MM", "code_information": [{"code": "72202536Q", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1423.44, "discounted_cash": 854.06, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TUBESET 20MM BLUNT 110-31-1120", "code_information": [{"code": "110-31-1120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1212.19, "discounted_cash": 727.31, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TURBINATE 2MM X 11 CM M4 ROTATES 360DEGINFERIOR XPS ENT STRAIGHT SHAFT W/", "code_information": [{"code": "1882040HR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 492.1, "discounted_cash": 295.26, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE UNIVERSAL MICROSAW 3600008-SS", "code_information": [{"code": "3600008-SS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1293.84, "discounted_cash": 776.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE WRENCH HARMONIC CURVED W/TORQUE SNGCB", "code_information": [{"code": "SNGCB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 771.49, "discounted_cash": 462.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE YOCO AKIN (KIT) CD-OP-1003-S", "code_information": [{"code": "CD-OP-1003-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADELESS OBTURATOR 8MM", "code_information": [{"code": "420023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 62.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLAKE 15FR ROUND WITHOUT TORCAR 2228", "code_information": [{"code": "2228", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 158.55, "discounted_cash": 95.13, "setting": "both", "billing_class": "facility"}]}, {"description": "BLAKE 7MM FLAT (F/FLTD) 2212", "code_information": [{"code": "2212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 284.37, "discounted_cash": 170.62, "setting": "both", "billing_class": "facility"}]}, {"description": "BLAKE DRN 15FR R/F 2229", "code_information": [{"code": "2229", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 387.32, "discounted_cash": 232.39, "setting": "both", "billing_class": "facility"}]}, {"description": "BLANKET OPERATING ROOM 24IN X 74IN UPPER BODY ALLIANCE BAIR HUGGER", "code_information": [{"code": "42268", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.41, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLANKET WARMING FULL BODY 30000", "code_information": [{"code": "30000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.37, "discounted_cash": 18.22, "setting": "both", "billing_class": "facility"}]}, {"description": "BLANKET WARMING LOWER BODY 52500", "code_information": [{"code": "52500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.68, "discounted_cash": 18.41, "setting": "both", "billing_class": "facility"}]}, {"description": "BLANKET WARMING LOWER WHITE NOVA+ 42534", "code_information": [{"code": "42534", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.68, "discounted_cash": 33.41, "setting": "both", "billing_class": "facility"}]}, {"description": "BLANKET WARMING OPERATING ROOM LOWER BODY BAIR HUGGER LF", "code_information": [{"code": "42568", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.41, "discounted_cash": 16.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLANKET WARMING PATIENT FULL BODY", "code_information": [{"code": "40034", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 58.46, "discounted_cash": 35.08, "setting": "both", "billing_class": "facility"}]}, {"description": "BLANKET WARMING SM LOWER BODY TEMPERATURE MANAGEMENT BAIR HUGGER", "code_information": [{"code": "53700", "type": "CDM"}], "standard_charges": [{"gross_charge": 36.16, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BLANKET WARMING UNDERBODY TEMPERTURE MANAGEMENT RDOLCNT BAIR HUGGER LF ADLT", "code_information": [{"code": "54500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.68, "discounted_cash": 44.21, "setting": "both", "billing_class": "facility"}]}, {"description": "BLANKET WARMING UNDRBDY FULL ACCESS 63500", "code_information": [{"code": "63500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 92.81, "discounted_cash": 55.69, "setting": "both", "billing_class": "facility"}]}, {"description": "BLANKET WARMING UPPERBODY HEADRAPE BAIR HUGGER LF DISP", "code_information": [{"code": "52200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.19, "discounted_cash": 22.91, "setting": "both", "billing_class": "facility"}]}, {"description": "BLASTOMYCES ANTIBODY", "code_information": [{"code": "86612", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 108.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 108.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 113.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 102.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 76.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 37.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 32.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD EXCHANGE TRUJ NEWBORN", "code_information": [{"code": "36450", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD EXCHANGE TRUJ OTH THN NB", "code_information": [{"code": "36455", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 14275.0, "setting": 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD PUSH TFUJ 2 YR/<", "code_information": [{"code": "36440", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 52.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 104.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 104.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 74.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 14.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLEPHAROPLASTY REVISION LOWER EYELID 15820", "code_information": [{"code": "15820", "type": "CPT"}, {"code": "1480197", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLEPHAROPLASTY REVISION LOWER EYELID EXTENSIVE 15821", "code_information": [{"code": "15821", "type": "CPT"}, {"code": "1480198", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLEPHAROPLASTY REVISION UPPER EYELID 15822", "code_information": [{"code": "15822", "type": "CPT"}, {"code": "1480199", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLEPHAROPLASTY REVISION UPPER EYELID EXTENSIVE 15823", "code_information": [{"code": "15823", "type": "CPT"}, {"code": "1480200", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLIND COR SINUS REDUCER IMPL", "code_information": [{"code": "C9783", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLIND INTERATRIAL SHUNT IDE", "code_information": [{"code": "C9758", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 37880.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 37880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34092.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLIND MYOCAR TRPL BON MARROW", "code_information": [{"code": "C9782", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 37880.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 37880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34092.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLIND/NONBLIND TRANS ATRIAL", "code_information": [{"code": "C9792", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLINK REFLEX TEST", "code_information": [{"code": "95933", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLM GENE", "code_information": [{"code": "81209", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 115.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOCK AUGMENT SZ 4 10MM TIBL NEXGEN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "-5988-004-27", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2542.62, "discounted_cash": 1525.57, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK AUGMENTATION 5MM X 65MM DIST FEMORAL LFT MEDIAL RIGHT LAT IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "184104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3788.32, "discounted_cash": 2272.99, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK AUGMENTATION 5MM X 65MM DIST FEMORAL RIGHT LAT LFT MEDIAL IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "184144", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3788.32, "discounted_cash": 2272.99, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK AUGMENTATION 5MM X 65MM POST FEMORAL LFT LAT RIGHT MEDIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "184164", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3788.32, "discounted_cash": 2272.99, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK AUGMENTATION 67MM X 6MM TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "141742", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3632.2, "discounted_cash": 2179.32, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CANCELLOUS 12MM X 12MM X 12MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "BL-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7529.9, "discounted_cash": 4517.94, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUTTING VISIONAIRE NON STRL", "code_information": [{"code": "V0200023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1064.0, "discounted_cash": 638.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SACROILIAC JOINT 27096", "code_information": [{"code": "27096", "type": "CPT"}, {"code": "1480201", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOCK SPONGE 12MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "745612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2609.5, "discounted_cash": 1565.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBIAL AUGMENT LFT LAT/ RT MED SZ3 5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "567-5203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3253.44, "discounted_cash": 1952.06, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBIAL AUGMENT RT LAT/ LFT MED SZ3 5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "567-5103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3253.44, "discounted_cash": 1952.06, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TRICORTICAL 7MM ALLOGRAFT", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "320107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1267.5, "discounted_cash": 760.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCKER CAP XIA 3 TI LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48230000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 950.91, "discounted_cash": 570.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCKER MANTIS REDUX ES 2 LITE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48289999", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1362.24, "discounted_cash": 817.34, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCKER XIA 4.5MM CERVICAL SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48130000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 204.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCKERS SPINE X19CT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48850000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 651.03, "discounted_cash": 390.62, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOOD CLOT LYSIS TIME", "code_information": [{"code": "85175", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 115.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 115.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 121.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 108.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 81.15, "methodology": "fee 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 29.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 59.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 59.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 62.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 395.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 355.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 264.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLUE LIGHT CYSTO IMAG AGENT", "code_information": [{"code": "C9738", "type": "HCPCS"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", 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"both", "billing_class": "facility"}]}, {"description": "BMC PURE KIT 120CC", "code_information": [{"code": "BC120-PURE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4320.0, "discounted_cash": 2592.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BMT 360 2.5MM OFFSET ADAPTER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "185210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2166.0, "discounted_cash": 1299.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BMT 360 5MM OFFSET ADAPTER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "185211", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2792.4, "discounted_cash": 1675.44, "setting": "both", "billing_class": "facility"}]}, {"description": "BMT 360 TIB AUG 67X15MM LL/RM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": 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"discounted_cash": 2179.32, "setting": "both", "billing_class": "facility"}]}, {"description": "BMT 360 TIB AUG 79X5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "185225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2629.2, "discounted_cash": 1577.52, "setting": "both", "billing_class": "facility"}]}, {"description": "BMT 360 TIB LG CRUCIATE WING", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "185651", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2326.8, "discounted_cash": 1396.08, "setting": "both", "billing_class": "facility"}]}, {"description": "BMT 360 TIB TRAY 67MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "185202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6112.6, "discounted_cash": 3667.56, "setting": "both", "billing_class": "facility"}]}, {"description": "BMT 360 TIB TRAY 71MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "185203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9094.8, "discounted_cash": 5456.88, "setting": "both", "billing_class": "facility"}]}, {"description": "BMT 360 TIB TRAY 83MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "185206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7670.0, "discounted_cash": 4602.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BMT HARV/TRANSPL 28D PKG", "code_information": [{"code": "S2150", "type": "HCPCS"}], "standard_charges": [{"minimum": 8982.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BMT SPLINED KNEE STM V2 12X80 148302", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "148302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3359.2, "discounted_cash": 2015.52, "setting": "both", "billing_class": "facility"}]}, {"description": "BMT SPLINED KNEE STM V2 14X40 148289", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "148289", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3359.2, "discounted_cash": 2015.52, "setting": "both", "billing_class": "facility"}]}, {"description": "BMX11MM DPTH 5XMM DIA CUTTER 874-425", "code_information": [{"code": "874-425", "type": "CDM"}], "standard_charges": [{"gross_charge": 347.28, "discounted_cash": 208.37, "setting": "both", "billing_class": "facility"}]}, {"description": "BMX11MM DPTH 7XMM DIA CUTTER 874-427", "code_information": [{"code": "874-427", "type": "CDM"}], "standard_charges": [{"gross_charge": 347.28, "discounted_cash": 208.37, "setting": "both", "billing_class": "facility"}]}, {"description": "BNP POCT", "code_information": [{"code": "83880", "type": "CPT"}, {"code": "1583577", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "gross_charge": 294.0, "discounted_cash": 176.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 127.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 255.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", 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"standard_charge_dollar": 179.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 114.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 97.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BNP POCT", "code_information": [{"code": "83880", "type": "CPT"}, {"code": "1583577", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "gross_charge": 419.0, "discounted_cash": 251.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee 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[{"code": "89050", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 54.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 108.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 108.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 114.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 103.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 76.82, "methodology": "fee 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{"code": "710.026.97S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2424.98, "discounted_cash": 1454.99, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE IMAGING 3 PHASE", "code_information": [{"code": "78315", "type": "CPT"}], "standard_charges": [{"minimum": 1082.89, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No 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"plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2174.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2289.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2060.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1533.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING LIMITED AREA", "code_information": [{"code": "78300", "type": "CPT"}], "standard_charges": [{"minimum": 298.88, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 298.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 600.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 600.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 631.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 568.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 423.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING MULTIPLE AREAS", "code_information": [{"code": "78305", "type": "CPT"}], "standard_charges": [{"minimum": 391.32, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 391.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 785.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 785.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 827.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 744.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 554.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING WHOLE BODY", "code_information": [{"code": "78306", "type": "CPT"}], "standard_charges": [{"minimum": 1015.07, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1015.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2038.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2038.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2146.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1931.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1437.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW ASPIRATE 60CC SPECIAL FILTER", "code_information": [{"code": "MAR01-SD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4968.0, "discounted_cash": 2980.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MARROW ASPIRATE NEEDLE  11 GAUGE  4 LENGTH D10011410", "code_information": [{"code": "C1830", "type": "HCPCS"}, {"code": "D10011410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 731.5, "discounted_cash": 438.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MARROW ASPIRATION BMA KIT 6EA. 8600BMA1", "code_information": [{"code": "8600BMA1", "type": "CDM"}], "standard_charges": [{"gross_charge": 173.16, "discounted_cash": 103.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MARROW ASPIRATION FOR BONE GRAFTING; SPINE SURGERY /SEPARATE INCISION 20939", "code_information": [{"code": "20939", "type": "CPT"}, {"code": "44897314", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 18989.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW ASPIRATION NEEDLE", "code_information": [{"code": "MC-RAN-13C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3024.0, "discounted_cash": 1814.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MARROW ASPIRATION NEEDLE KIT JAMSHIDI 11 GAUGE 21-5011", "code_information": [{"code": "21-5011", "type": "CDM"}], "standard_charges": [{"gross_charge": 189.6, "discounted_cash": 113.76, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MARROW ASPIRATION NEEDLES BMA NEEDLE  and  10CC SYRINGE PACK 11G  11CM  0 PORTS 2604-90022", "code_information": [{"code": "2604-90022", "type": "CDM"}], "standard_charges": [{"gross_charge": 419.49, "discounted_cash": 251.69, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MARROW ASPIRATION ONLY 38220", "code_information": [{"code": "38220", "type": "CPT"}, {"code": "1643980", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW HARVEST ALLOGEN", "code_information": [{"code": "38230", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW HARVESTING FOR TRANSPLANTATION; AUTOLOGOUS 38232", "code_information": [{"code": "38232", "type": "CPT"}, {"code": "26440562", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3070.0, "maximum": 10329.0, "gross_charge": 9222.0, "discounted_cash": 5533.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 5072.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING BODY", "code_information": [{"code": "78104", "type": "CPT"}], "standard_charges": [{"minimum": 307.6, "maximum": 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52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 307.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 617.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 617.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 650.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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221.24, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 221.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 444.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 444.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 467.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 421.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 313.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING MULT", "code_information": [{"code": "78103", "type": "CPT"}], "standard_charges": [{"minimum": 280.14, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 280.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 562.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 562.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 592.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 533.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 396.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW INTERPRETATION", "code_information": [{"code": "85097", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 130.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 261.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 261.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 275.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 248.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 184.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 139.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 118.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW NEEDLE 70-3010", "code_information": [{"code": "70-3010", "type": "CDM"}], "standard_charges": [{"gross_charge": 631.09, "discounted_cash": 378.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MATRIX IMPLANT 1CC LEGACY DBM 420801", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "420801", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MATRIX IMPLANT LEGACY DBM 5CC 420805", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "420805", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MATRIX LEGACY DBM 10CC 420810", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "420810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2240.0, "discounted_cash": 1344.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MATRIX OSTEOSURGE DEMIN 10CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "56510100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5775.74, "discounted_cash": 3465.44, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MINERAL DUAL PHOTON", "code_information": [{"code": "78351", "type": "CPT"}], "standard_charges": [{"minimum": 33.72, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 67.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 67.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 71.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 64.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 47.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 46.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 39.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MINERAL SINGLE PHOTON", "code_information": [{"code": "78350", "type": "CPT"}], "standard_charges": [{"minimum": 50.6, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for 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PPO DFW", "standard_charge_dollar": 106.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 96.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 71.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 97.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 82.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MODEL GUIDE PAT SPECIFIC", "code_information": [{"code": "98-8500-000-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MODEL PAT SPEC FEMUR/TIBIA", "code_information": [{"code": "-5970-000-10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 665.0, "discounted_cash": 399.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MODEL PAT SPECIFIC", "code_information": [{"code": "98-8500-000-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MODEL RIGHT COMPR TOTAL SHOULDER GD AND  20-8090-002-02", "code_information": [{"code": "c1713", "type": "HCPCS"}, {"code": "20-8090-002-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1544.4, "discounted_cash": 926.64, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PIN  3.2MM X 140MM STERILE 2 PACK 111620", "code_information": [{"code": "111620", "type": "CDM"}], "standard_charges": [{"gross_charge": 130.77, "discounted_cash": 78.46, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PIN  3.2MM X 80MM STERILE 2 PACK 111670", "code_information": [{"code": "111670", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.77, "discounted_cash": 78.46, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RASP 10MM WIDTH 389.334", "code_information": [{"code": "389.334", "type": "CDM"}], "standard_charges": [{"gross_charge": 2039.04, "discounted_cash": 1223.42, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RASP 61370000", "code_information": [{"code": "61370000", "type": "CDM"}], "standard_charges": [{"gross_charge": 508.06, "discounted_cash": 304.84, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RASP 8MM 389.715", "code_information": [{"code": "389.715", "type": "CDM"}], "standard_charges": [{"gross_charge": 1671.84, "discounted_cash": 1003.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RASP 8MM WIDTH-LEFT 389.286", "code_information": [{"code": "389.286", "type": "CDM"}], "standard_charges": [{"gross_charge": 2077.92, "discounted_cash": 1246.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RASP 8MM WIDTH-RIGHT 389.285", "code_information": [{"code": "389.285", "type": "CDM"}], "standard_charges": [{"gross_charge": 2077.92, "discounted_cash": 1246.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RASP 8MM-STRAIGHT 389.714", "code_information": [{"code": "389.714", "type": "CDM"}], "standard_charges": [{"gross_charge": 2916.0, "discounted_cash": 1749.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE REMOVAL SCREW 5801-0092", "code_information": [{"code": "5801-0092", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 996.17, "discounted_cash": 597.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE REMOVAL SCREW STERILE 5801-0015", "code_information": [{"code": "5801-0015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 996.17, "discounted_cash": 597.7, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RONGEUR CURVED 5MM X 24CM U41-545-24", "code_information": [{"code": "U41-545-24", "type": "CDM"}], "standard_charges": [{"gross_charge": 1935.36, "discounted_cash": 1161.22, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RONGEUR CURVED 7MM X 24CM U41-547-24", "code_information": [{"code": "U41-547-24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2090.88, "discounted_cash": 1254.53, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RONGEUR CURVED 8MM X 23CM U41-565-23", "code_information": [{"code": "U41-565-23", "type": "CDM"}], "standard_charges": [{"gross_charge": 2244.24, "discounted_cash": 1346.54, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RONGEUR DOUBLE-ACTING/12MM WIDTH 389.49", "code_information": [{"code": "389.49", "type": "CDM"}], "standard_charges": [{"gross_charge": 7968.24, "discounted_cash": 4780.94, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RONGEUR DOUBLE-ACTING/8MM WIDTH 389.48", "code_information": [{"code": "389.48", "type": "CDM"}], "standard_charges": [{"gross_charge": 7542.72, "discounted_cash": 4525.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RONGEUR SIDE-BITING 11MM HEIGHT 03.808.023", "code_information": [{"code": "3.808.023", "type": "CDM"}], "standard_charges": [{"gross_charge": 9910.08, "discounted_cash": 5946.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RONGEUR SIDE-BITING 13MM HEIGHT 03.808.024", "code_information": [{"code": "3.808.024", "type": "CDM"}], "standard_charges": [{"gross_charge": 9910.08, "discounted_cash": 5946.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RONGEUR SIDE-BITING 15MM HEIGHT 03.808.025", "code_information": [{"code": "3.808.025", "type": "CDM"}], "standard_charges": [{"gross_charge": 9910.08, "discounted_cash": 5946.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RONGEUR SIDE-BITING 17MM HEIGHT 03.808.026", "code_information": [{"code": "3.808.026", "type": "CDM"}], "standard_charges": [{"gross_charge": 9910.08, "discounted_cash": 5946.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RONGEUR SIDE-BITING 19MM HEIGHT 03.808.027", "code_information": [{"code": "3.808.027", "type": "CDM"}], "standard_charges": [{"gross_charge": 9910.08, "discounted_cash": 5946.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RONGEUR SIDE-BITING 21MM HEIGHT 03.808.028", "code_information": [{"code": "3.808.028", "type": "CDM"}], "standard_charges": [{"gross_charge": 9910.08, "discounted_cash": 5946.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RONGEUR SIDE-BITING 9MM HEIGHT 03.808.022", "code_information": [{"code": "3.808.022", "type": "CDM"}], "standard_charges": [{"gross_charge": 9910.08, "discounted_cash": 5946.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RONGEUR STRAIGHT 10MM X 22CM U41-570-22", "code_information": [{"code": "U41-570-22", "type": "CDM"}], "standard_charges": [{"gross_charge": 2205.36, "discounted_cash": 1323.22, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RONGEUR/DOUBLE-ACTING WITHOUT TEETH/12MM 389.491", "code_information": [{"code": "389.491", "type": "CDM"}], "standard_charges": [{"gross_charge": 7968.24, "discounted_cash": 4780.94, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE RONGEUR/DOUBLE-ACTING WITHOUT TEETH/8MM 389.481", "code_information": [{"code": "389.481", "type": "CDM"}], "standard_charges": [{"gross_charge": 7542.72, "discounted_cash": 4525.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW 3.0 MM X 60MM LONG 20MM THREAD M732", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "M732", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 405.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW 4.0MM X 42.0MM W/ T25 STARDRV RECESS SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2.204.042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 566.2, "discounted_cash": 339.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW 5.0MM X 32.0MM W/ T25 SRATDRIVE RECESS SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.21", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 576.51, "discounted_cash": 345.91, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW ACETABULAR 6.5MM X 40MM 1501-865-040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1501-865-040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 487.74, "discounted_cash": 292.64, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW ACETABULAR 6.5MM X 45MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1501-865-045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 502.77, "discounted_cash": 301.66, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW T8 656106", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 492.0, "discounted_cash": 295.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW T8 656107", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 492.0, "discounted_cash": 295.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW T8 FULL THREAD 2.4MM/L18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 463.13, "discounted_cash": 277.88, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE STAPLE COMPRESSION SYSTEM DYNAMIC EASY FUSE 20 X 20MM FFS22020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFS22020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4609.8, "discounted_cash": 2765.88, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE STAPLES 3 ARTHROSCOPIC DELIVERY SET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2503-A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2240.0, "discounted_cash": 1344.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE TAP CANNULATED 5.5MM", "code_information": [{"code": "AR-8956C-55T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 465.5, "discounted_cash": 279.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE TAP FOR 2.7MM HEXALOBE SCREWS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "80-0625", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 828.0, "discounted_cash": 496.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE VOID FILLER CC OSTEOVATION EX", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "390-0005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5148.0, "discounted_cash": 3088.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE WAX  LUKENS 901", "code_information": [{"code": "901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.28, "discounted_cash": 12.77, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE WAX DYNJBW25", "code_information": [{"code": "DYNJBW25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.93, "discounted_cash": 13.16, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE WEDGE 8MM EVANS  MWEV0008", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "MWEV0008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4680.0, "discounted_cash": 2808.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT GREAT TOE", "code_information": [{"code": "20973", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT ILIAC CREST", "code_information": [{"code": "20970", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT METATARSAL", "code_information": [{"code": "20972", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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[{"gross_charge": 1844.64, "discounted_cash": 1106.78, "setting": "both", "billing_class": "facility"}]}, {"description": "BOX CURETTE/SMALL-RIGHT 389.834", "code_information": [{"code": "389.834", "type": "CDM"}], "standard_charges": [{"gross_charge": 1844.64, "discounted_cash": 1106.78, "setting": "both", "billing_class": "facility"}]}, {"description": "BOX LCK 8 3/8IN X 2 7/8IN X 4 1/2IN CLR REFRIGERATOR COMPACT SNGL LOCK HINGED DO", "code_information": [{"code": "3746-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 189.28, "discounted_cash": 113.57, "setting": "both", "billing_class": "facility"}]}, {"description": "BRA POST SURGICAL 3XL LF 46518-06LF", "code_information": [{"code": "46518-06LF", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 123.93, "discounted_cash": 74.36, "setting": "both", "billing_class": "facility"}]}, {"description": "BRA POST SURGICAL LG LF 46518-03LF", "code_information": [{"code": "46518-03LF", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 108.41, "discounted_cash": 65.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BRA POST SURGICAL MD LF 46518-02LF", "code_information": [{"code": "46518-02LF", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 121.43, "discounted_cash": 72.86, "setting": "both", "billing_class": "facility"}]}, {"description": "BRA POST SURGICAL XL LFL X-LARGE 46518-04LF", "code_information": [{"code": "46518-04LF", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 121.43, "discounted_cash": 72.86, "setting": "both", "billing_class": "facility"}]}, {"description": "BRA POSTOPERATIVE EXTRA XL 42IN TO 44IN SPANDEX W/ PADDED SHOULDER STRAPS VELCO", "code_information": [{"code": "46518-05LF", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 121.43, "discounted_cash": 72.86, "setting": "both", "billing_class": "facility"}]}, {"description": "BRA POSTOPERATIVE SM 34IN TO 36IN SPANDEX W/ PADDED SHOULDER STRAPS VELCO CLOSUR", "code_information": [{"code": "46518-01LF", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 108.41, "discounted_cash": 65.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BRA SUGICAL PADDED SHOULDER 2X-LARGE SB-2XL", "code_information": [{"code": "SB-2XL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 136.45, "discounted_cash": 81.87, "setting": "both", "billing_class": "facility"}]}, {"description": "BRA SUGICAL PADDED SHOULDER 3X-LARGE SB-3XL", "code_information": [{"code": "SB-3XL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 123.93, "discounted_cash": 74.36, "setting": "both", "billing_class": "facility"}]}, {"description": "BRA SUGICAL PADDED SHOULDER MEDIUM SB-MED", 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[{"gross_charge": 49.77, "discounted_cash": 29.86, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE WRST MED 6.25IN TO 7.75IN BLACK RIGHT ADJ STRP W/ THUMB SPICA", "code_information": [{"code": "5WTMR", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 49.77, "discounted_cash": 29.86, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACHIOPLASTY 15836", "code_information": [{"code": "15836", "type": "CPT"}, {"code": "1480203", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"plan_name": "BCBS HMO DFW", "standard_charge_dollar": 778.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 819.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 737.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 548.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1570.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1334.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISODOSE PLAN SIMPLE", "code_information": [{"code": "77316", "type": "CPT"}], "standard_charges": [{"minimum": 334.77, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 707.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 636.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 474.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1570.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1334.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAF GENE", "code_information": [{"code": "81210", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 319.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 642.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 642.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 675.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 608.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 452.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 513.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 436.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR COMPLX", "code_information": [{"code": "61697", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR COMPLX", "code_information": [{"code": "61698", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR SIMPLE", "code_information": [{"code": "61700", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN BIOPSY W/CT/MR GUIDE", "code_information": [{"code": "61751", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN FLOW IMAGING ONLY", "code_information": [{"code": "78610", "type": "CPT"}], "standard_charges": [{"minimum": 218.59, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 439.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 462.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 415.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 309.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE 4+ VIEWS", "code_information": [{"code": "78605", "type": "CPT"}], "standard_charges": [{"minimum": 469.79, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 469.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 943.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 943.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 993.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 893.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 665.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE < 4 VIEWS", "code_information": [{"code": "78600", "type": "CPT"}], "standard_charges": [{"minimum": 756.21, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 756.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1518.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1518.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1598.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1438.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1071.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE W/FLOW 4 + VIEWS", "code_information": [{"code": "78606", "type": "CPT"}], "standard_charges": [{"minimum": 413.74, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 413.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 830.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 830.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 874.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 787.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 586.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE W/FLOW < 4 VIEWS", "code_information": [{"code": "78601", "type": "CPT"}], "standard_charges": [{"minimum": 435.43, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 435.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 874.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 874.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 920.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 828.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 616.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGING (PET)", "code_information": [{"code": "78608", "type": "CPT"}], "standard_charges": [{"minimum": 2790.01, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2790.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5603.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 5603.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 5898.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5308.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 3952.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGING (PET)", "code_information": [{"code": "78609", "type": "CPT"}], "standard_charges": [{"minimum": 1938.64, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1938.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3893.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3893.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4098.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3688.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2746.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1 BRCA2 MRNA SEQ ALYS", "code_information": [{"code": "138U", "type": "CPT"}], "standard_charges": [{"minimum": 1165.59, "maximum": 1371.37, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1371.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1165.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1 GENE FULL DUP/DEL ALYS", "code_information": [{"code": "81166", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 882.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", 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WITH CC/MCC", "code_information": [{"code": "584", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13736.08, "maximum": 23221.61, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 23221.61, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13736.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "585", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11492.24, "maximum": 22515.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 22515.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11492.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST DIEP OR SIEA FLAP", "code_information": [{"code": "S2068", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST GAP FLAP RECONST", "code_information": [{"code": "S2066", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST IMPLANT  HIGH PROFILE XTRA 500 CC  SMHX-500 SMHX-500", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "SMHX-500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2548.0, "discounted_cash": 1528.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BREAST IMPLANT 410 STYLE FF 655CC", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "FF-410655", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3380.0, "discounted_cash": 2028.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BREAST IMPLANT HIGH PROFILE XTRA 545 CC SMOOTH ROUND SILICONE SMHX-545 SMHX-545", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "SMHX-545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2548.0, "discounted_cash": 1528.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BREAST IMPLANT MEMORY GEL RND 790CC", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "SHPX790", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2626.0, "discounted_cash": 1575.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BREAST IMPLANT MEMORYGEL XTRA MODERATE HIGH MHX SMOOTH SIZER 500CC  RSZ-SMHX500S RSZ-SMHX500S", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "RSZ-SMHX500S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 672.0, "discounted_cash": 403.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BREAST IMPLANT MEMORYGEL XTRA MODERATE HIGH MHX SMOOTH SIZER 545CC  RSZ-SMHX545S RSZ-SMHX545S", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "RSZ-SMHX545S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 672.0, "discounted_cash": 403.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BREAST IMPLANT SMOOTH MODERATE HIGH PROFILE XTRA 430 CC |SMOOTH|ROUND|SILICONE| SMHX-430", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "SMHX-430", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2548.0, "discounted_cash": 1528.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BREAST IMPLANT SMOOTH MODERATE HIGH PROFILE XTRA 470 CC SMOOTH ROUND SILICONE SMHX-470", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "SMHX-470", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2548.0, "discounted_cash": 1528.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BREAST IMPLANT SMOOTH ROUND ULTRA HIG PROFILE 650CC", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "350-5650BC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2101.2, "discounted_cash": 1260.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BREAST IMPLANT SMOOTH ROUND ULTRA HIG PROFILE 700BC", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "350-5700BC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2307.2, "discounted_cash": 1384.32, "setting": "both", "billing_class": "facility"}]}, {"description": "BREAST IMPLANT SMOOTH ROUND ULTRA HIG PROFILE 750 CC", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "350-5750BC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2237.2, "discounted_cash": 1342.32, "setting": "both", "billing_class": "facility"}]}, {"description": "BREAST IMPLANT SMOOTH ROUND ULTRA HIG PROFILE 800CC", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "350-5800BC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2237.2, "discounted_cash": 1342.32, "setting": "both", "billing_class": "facility"}]}, {"description": "BREAST RECON W/MICROVASCULAR ANASTOMOSIS SUPRECHARGING 19368", "code_information": [{"code": "19368", "type": "CPT"}, {"code": "1792994", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST RECON W/TRANSERSE RECTUS ABD MYO FLAP  TRAM SINGLE PED. W/CLOSURE 19367", "code_information": [{"code": "19367", "type": "CPT"}, {"code": "1792993", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST RECON W/TRANSVERSE REC ABD MYO FLAP TRAM DOUBLE PED. W/CLOSURE 19369", "code_information": [{"code": "19369", "type": "CPT"}, {"code": "1792995", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST TISSUE EXPANDER SUTURE TABS INTEGRAL INJECTION DOME 375CC SDC-120H", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "SDC-120H", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5408.0, "discounted_cash": 3244.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BREAST TOMOSYNTHESIS BI", "code_information": [{"code": "77062", "type": "CPT"}], "standard_charges": [{"minimum": 173.45, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 173.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 348.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 348.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 366.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 330.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 245.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 518.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 440.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST TOMOSYNTHESIS BI", "code_information": [{"code": "77063", "type": "CPT"}], "standard_charges": [{"minimum": 51.29, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 103.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 103.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 108.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 97.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 72.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 111.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 95.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST TOMOSYNTHESIS UNI", "code_information": [{"code": "77061", "type": "CPT"}], "standard_charges": [{"minimum": 129.87, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 129.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 260.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 260.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 274.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 247.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 183.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 406.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 345.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREATH HYDROGEN/METHANE TEST", "code_information": [{"code": "91065", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREATH RECORDING INFANT", "code_information": [{"code": "94772", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREATH TEST ANALYSIS C-14", "code_information": [{"code": "78268", "type": "CPT"}], "standard_charges": [{"minimum": 126.93, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 254.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 254.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 268.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 241.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 179.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 433.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 368.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREATH TST ATTAIN/ANAL C-14", "code_information": [{"code": "78267", "type": "CPT"}], "standard_charges": [{"minimum": 20.76, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 41.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 41.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 43.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 39.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 51.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 43.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREG POLAR CARE CUBE W/XL MULTIUSE PAD", "code_information": [{"code": "10710", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 249.29, "discounted_cash": 149.57, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIEF CLOTHLIKE FITULTRA XLG 56-64 FITULTRAXLG", "code_information": [{"code": "FITULTRAXLG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.16, "discounted_cash": 1.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIEF EMOTIONAL/BEHAV ASSMT", "code_information": [{"code": "96127", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIGADE HL   10X28X38   20DEG 7502104", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7502104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIGADE HL   6X28X38   20DEG 7502100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7502100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIGADE HL   8X28X38   20DEG 7502102", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7502102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIGADE LATERAL 10X38X28MM 10 6968470", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6968470", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 6600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIGADE LATERAL 10X38X28MM 15 6983038", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6983038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 6600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIMONIDINE 0.2% (ALPHAGAN) OPHTHALMIC DROP 5ML", "code_information": [{"code": "MED0033", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 32.57, "discounted_cash": 19.54, "setting": "both", "billing_class": "facility"}]}, {"description": "BRNCHSC RF DSTRJ PLM NRV UNI", "code_information": [{"code": "782T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRNCHSC RF DSTRJ PULM NRV BI", "code_information": [{"code": "781T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRNCHSC W/THER ASPIR 1ST", "code_information": [{"code": "31645", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRNCHSC W/THER ASPIR SBSQ", "code_information": [{"code": "31646", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BROACH IMPLANT SZ 1 AND 2", "code_information": [{"code": "MDBRSM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1173.06, "discounted_cash": 703.84, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH IMPLANT SZ 3 AND 4", "code_information": [{"code": "MDBRLG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1173.06, "discounted_cash": 703.84, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH TIGER EXPRESS", "code_information": [{"code": "TN-300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1044.05, "discounted_cash": 626.43, "setting": "both", "billing_class": "facility"}]}, {"description": "BRONCH EBUS IVNTJ PERPH LES", "code_information": [{"code": "31654", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS SAMPLNG 1/2 NODE", "code_information": [{"code": "31652", "type": "CPT"}], "standard_charges": [{"minimum": 3866.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS SAMPLNG 3/> NODE", "code_information": [{"code": "31653", "type": "CPT"}], "standard_charges": [{"minimum": 3866.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH LAVAGE W/EBUS", "code_information": [{"code": "C7556", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH THERMOPLSTY 1 LOBE", "code_information": [{"code": "31660", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH THERMOPLSTY 2/> LOBES", "code_information": [{"code": "31661", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH W/BALLOON OCCLUSION", "code_information": [{"code": "31634", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH/BPSY(S) W/ EBUS", "code_information": [{"code": "C7512", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH/BPSY(S) W/ NAVIGATION", "code_information": [{"code": "C7511", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH/LAVAG W/ NAVIGATION", "code_information": [{"code": "C7510", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL ALLERGY TESTS", "code_information": [{"code": "95070", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL BRUSH BIOPSY", "code_information": [{"code": "31717", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE ADDL INSERT", "code_information": [{"code": "31651", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE INIT INSERT", "code_information": [{"code": "31647", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE REMOV ADDL", "code_information": [{"code": "31649", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE REMOV INIT", "code_information": [{"code": "31648", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHITIS AND ASTHMA WITH CC/MCC", "code_information": [{"code": "202", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6900.33, "maximum": 10964.31, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10964.31, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6900.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHITIS AND ASTHMA WITHOUT CC/MCC", "code_information": [{"code": "203", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5115.98, "maximum": 7900.84, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7900.84, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5115.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPE ASCOPE 4 REGULAR 477101000", "code_information": [{"code": "477101000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 667.66, "discounted_cash": 400.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRONCHOSCOPE SWIVEL", "code_information": [{"code": "625191", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.88, "discounted_cash": 35.93, "setting": "both", "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY BRONCH STENTS", "code_information": [{"code": "31636", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": 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"0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY DX W/ OR W/O CELL WASH OR BRUSH 31622", "code_information": [{"code": "31622", "type": "CPT"}, {"code": "1643972", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY FLEX. OR RIDGID W/FLOURO W/TRACHEAL/BRONCHIAL DILATION OR CLOSED RED. OF FX 31630", "code_information": [{"code": "31630", "type": "CPT"}, {"code": "22139262", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY REVISE STENT", "code_information": [{"code": "31638", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF 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"UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/BIOPSY(S)", "code_information": [{"code": "31625", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee 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[{"code": "31635", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/MARKERS", "code_information": [{"code": "31626", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 9519.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/LUNG BX ADDL", "code_information": [{"code": "31632", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/LUNG BX EACH", "code_information": [{"code": "31628", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/NEEDLE BX ADDL", "code_information": [{"code": "31633", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, 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"plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/NEEDLE BX EACH", "code_information": [{"code": "31629", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRUCELLA ANTIBODY", "code_information": [{"code": "86622", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 106.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 106.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 112.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 100.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 75.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 26.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 22.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRUSH BIOPSY  G14919", "code_information": [{"code": "G14919", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 365.74, "discounted_cash": 219.44, "setting": "both", "billing_class": "facility"}]}, {"description": "BRUSH CHANNEL CLEANING ANTIMICROBIAL BRISTLES STAINLESS STEEL HANDLE .236IN DIAM 16IN LONG", "code_information": [{"code": "BR-16-236", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.86, "discounted_cash": 10.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BRUSH CHANNEL CLEANING ANTIMICROBIAL BRISTLES STAINLESS STEEL HANDLE .443IN DIAM 16IN LONG", "code_information": [{"code": "BR-16-443", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.86, "discounted_cash": 10.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BRUSH CLEANING TOOTHBRUSH-STYLE DOUBLE-ENDED STAINLESS STEEL 7IN LONG", "code_information": [{"code": "S-2121-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.62, "discounted_cash": 11.77, "setting": "both", "billing_class": "facility"}]}, {"description": "BRUSHES CHANNEL CLEANING 1.5IN X 8IN", "code_information": [{"code": "BR-08-118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.86, "discounted_cash": 10.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BSO OMENTECTOMY W/TAH", "code_information": [{"code": "58956", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for 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"standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BSS 15ML OPHTHALMIC SOLUTION", "code_information": [{"code": "MED0034", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 16.12, "discounted_cash": 9.67, "setting": "both", "billing_class": "facility"}]}, {"description": "BSS 30ML OPHTHALMIC SOLUTION", "code_information": [{"code": "MED0035", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 59.36, "discounted_cash": 35.62, "setting": "both", "billing_class": 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"AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 513.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 436.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUCCAL/LABIAL FRENECTOMY", "code_information": [{"code": "D7961", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 2566.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BULKAMID URETHERAL BULKING SYSTEM 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"MED0042", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 31.13, "discounted_cash": 18.68, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE 0.5% PF 10ML", "code_information": [{"code": "MED0355", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.86, "discounted_cash": 5.92, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE 0.5% PF 30 ML", "code_information": [{"code": "MED0358", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 31.13, "discounted_cash": 18.68, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE DEXTROSE 0.75% 2ML VIAL (MARCAINE SPINAL)", "code_information": [{"code": "MED0047", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.36, "discounted_cash": 7.42, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE PF 0.75% 10ML (SENSORCAINE-MPF)", "code_information": [{"code": "MED0046", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.64, "discounted_cash": 6.98, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE/DW 0.75% INTRATHECAL 2ML (MARCAINE SPINAL)", "code_information": [{"code": "MED0043", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.36, "discounted_cash": 7.42, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE/EPI 0.25% (SENSORCAINE) 50ML", "code_information": [{"code": "MED0040", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 23.41, "discounted_cash": 14.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE/EPI 0.25% (SENSORCAINE/EPI) 30ML", "code_information": [{"code": "MED0039", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 16.79, "discounted_cash": 10.07, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE/EPI 0.25% 10ML (SENORCAINE)", "code_information": [{"code": "MED0038", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.81, "discounted_cash": 7.69, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE/EPI 0.5% (SENSORCAINE/EPI)  30ML", "code_information": [{"code": "MED0045", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 16.07, "discounted_cash": 9.64, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE/EPI 0.5% 50ML VIAL", "code_information": [{"code": "MED0219", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 23.32, "discounted_cash": 13.99, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE/EPI 0.5%-1:200K PF INJ 10ML", "code_information": [{"code": "MED0044", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.91, "discounted_cash": 7.15, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE/EPI DENTAL 0.5% 1.8ML CARTRIDGE (VIVACAINE)", "code_information": [{"code": "MED0048", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.42, "discounted_cash": 5.65, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPROPION HCL SR 60 TABLETS", "code_information": [{"code": "S0106", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUR 3.0MM NEURO MATCH HEAD BR5820-107-530", "code_information": [{"code": "BR5820-107-530", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 142.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR 4.0MM ROUND FLUTED 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"billing_class": "facility"}]}, {"description": "BUR 6 FLUTE BARREL 5.5MM", "code_information": [{"code": "375-951-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 205.91, "discounted_cash": 123.55, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR BONE CUTTING 15DEG 1.4MM X 15CM ANTERIOR SKULL BASE", "code_information": [{"code": "1884075HSE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 920.41, "discounted_cash": 552.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR CARBIDE ROUND 2.0MM 5820-110-020C", "code_information": [{"code": "5820-110-020C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 638.69, "discounted_cash": 383.21, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR CARBIDE ROUND 3.0MM 5820-110-030C", "code_information": [{"code": "5820-110-030C", "type": "CDM"}, {"code": "272", 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"RC"}], "standard_charges": [{"gross_charge": 176.99, "discounted_cash": 106.19, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR HPS 45MM X 19CM PRE-BENT POLISHING", "code_information": [{"code": "HSP-HB02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 347.6, "discounted_cash": 208.56, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR MATCH HEAD 3.0MM 13CM", "code_information": [{"code": "8450-107-030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 428.85, "discounted_cash": 257.31, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR MIS 16CM 3.0MM PRECISION MATCH HEAD 8470-107-530", "code_information": [{"code": "8470-107-530", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 601.4, "discounted_cash": 360.84, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR ORTHOPAEDIC SMALL TEAR 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"setting": "both", "billing_class": "facility"}]}, {"description": "BUR ROUND 6.0MM", "code_information": [{"code": "1608-2-15", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 158.37, "discounted_cash": 95.02, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR ROUND POLISHING 2.0MM", "code_information": [{"code": "1608-006-159", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 117.73, "discounted_cash": 70.64, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR SINUS TAPERED DIAMOND 4.0MM X 13CM 70DEG CURVED 1883672HS", "code_information": [{"code": "1883672HS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 196.87, "discounted_cash": 118.12, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR  LARGE 6105.2014", "code_information": [{"code": "6105.2014", "type": "CDM"}], "standard_charges": [{"gross_charge": 1183.68, "discounted_cash": 710.21, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR  MEDIUM 6105.2012", "code_information": [{"code": "6105.2012", "type": "CDM"}], "standard_charges": [{"gross_charge": 1183.68, "discounted_cash": 710.21, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR  ROUND FINE DIAMOND STERILE DISPOSABLE  5820-012-020D", "code_information": [{"code": "5820-012-020D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 374.37, "discounted_cash": 224.62, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR  SMALL 6105.201", "code_information": [{"code": "6105.201", "type": "CDM"}], "standard_charges": [{"gross_charge": 1183.68, "discounted_cash": 710.21, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR 4.0 BURSECTOR 0475-541-000", "code_information": [{"code": "475-541-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 250.27, "discounted_cash": 150.16, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ABRADER 4MM HIP DYONICS HIGH VISIBILITY SHEATH", "code_information": [{"code": "72203128", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 151.59, "discounted_cash": 90.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ABRADER 5.5MM DYONICS HIGH VISIBILITY SHEATH", "code_information": [{"code": "72203127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 151.59, "discounted_cash": 90.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ABRADER 5.5MM X 18 CM BLACK LNG SHAVER PARTIAL HOOD", "code_information": [{"code": "72200082", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 214.88, "discounted_cash": 128.93, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR BARREL 12 FLUTE 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"discounted_cash": 92.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CARTILAGE CYLINDER 4 X 16MM PROSTEP MIS 58CC4016", "code_information": [{"code": "58CC4016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1244.88, "discounted_cash": 746.93, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CORTICAL WEDGE 3.1X13MM 58RW3113", "code_information": [{"code": "58RW3113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1298.16, "discounted_cash": 778.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CUTTER 3MM 14 CM DRILL BIT MATCH HEAD MIDAS REX LEGENDINSTR", "code_information": [{"code": "14MH30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 225.15, "discounted_cash": 135.09, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CUTTER 4MM 14 CM DRILL BIT BALL FLUTED MIDAS 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{"description": "BURSECTOMY TROCHANTERIC 27062", "code_information": [{"code": "27062", "type": "CPT"}, {"code": "1480211", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": 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{"description": "BUTTOCK FASCIOTOMY", "code_information": [{"code": "27027", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUTTOCK FASCIOTOMY W/DBRDMT", "code_information": [{"code": "27057", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUTTON CANNULA PASSPORT LOW PROFILE 8MM X 4CM", "code_information": [{"code": "AR-6592-08-40", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.06, "discounted_cash": 101.44, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON NASAL SEPTAL 2 PART", "code_information": [{"code": "1524110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 464.2, "discounted_cash": 278.52, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON NASAL SPETAL 5CM OVERSIZE", "code_information": [{"code": "L8047", "type": "HCPCS"}, {"code": "SP-78105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 529.2, "discounted_cash": 317.52, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON OBLONG TIGHTROPE ABS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TB-2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 864.0, "discounted_cash": 518.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON PROXIMAL TENODESIS REV 0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2291", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1305.0, "discounted_cash": 783.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON SEPTAL 3 CM X 4MM STANDARD SZ NASAL", "code_information": [{"code": "L8047", "type": "HCPCS"}, {"code": "SP-78100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.07, "discounted_cash": 250.84, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON SUT 12MM X 20MM LOOP CORTICAL BONE SUT FXTN FOR SOFT TISSUE AND BTB GRAFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588-20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1008.0, "discounted_cash": 604.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON SUT 3.5MM STRL DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8920", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 544.0, "discounted_cash": 326.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON SUT DOG BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2270", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON TIGHTROPE 144MM ROUND ABS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TB-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 918.0, "discounted_cash": 550.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON TIGHTROPE 8MM X 12MM ABS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TB", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 614.18, "discounted_cash": 368.51, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON TIGHTROPE ABS 11MM ROUND CONCAVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TB-3", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 576.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON TIGHTROPE ABS 12MM ROUND CONCAVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TB-5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 672.0, "discounted_cash": 403.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON TIGHTROPE ABS 14MM ROUND CONCAVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TB-4", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 576.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTRESS 1-HOLE COVER 8606-0100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8606-0100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3913.0, "discounted_cash": 2347.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION MR IMAG", "code_information": [{"code": "19085", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION STRTCTC", "code_information": [{"code": "19081", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION MR IMAG", "code_information": [{"code": "19086", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee 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HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION STRTCTC", "code_information": [{"code": "19082", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION US IMAG", "code_information": [{"code": "19084", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 37.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 32.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CA SCREEN;FLEXI SIGMOIDSCOPE", "code_information": [{"code": "G0104", "type": "HCPCS"}], "standard_charges": [{"minimum": 1659.0, "maximum": 3989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ART-VEIN SIX OR MORE", "code_information": [{"code": "33523", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL FOUR OR MORE", "code_information": [{"code": "33536", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL SINGLE", "code_information": [{"code": "33533", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL THREE", "code_information": [{"code": "33535", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL TWO", "code_information": [{"code": "33534", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN FIVE", "code_information": [{"code": "33522", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN FOUR", "code_information": [{"code": "33521", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN SINGLE", "code_information": [{"code": "33517", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN THREE", "code_information": [{"code": "33519", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN TWO", "code_information": [{"code": "33518", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN FIVE", "code_information": [{"code": "33514", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN FOUR", "code_information": [{"code": "33513", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN SINGLE", "code_information": [{"code": "33510", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN SIX OR MORE", "code_information": [{"code": "33516", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN THREE", "code_information": [{"code": "33512", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN TWO", "code_information": [{"code": "33511", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABLE 2 TEMP CARE XTN PRB 20IN", "code_information": [{"code": "2016998-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 541.84, "discounted_cash": 325.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE ASSY SP02NELCOR OXYMAX 3 SMART", "code_information": [{"code": "2021406-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 423.03, "discounted_cash": 253.82, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE COBALT CHROME 1.7MM 750MM W/ TI CRIMP STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "611.105.01S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1688.58, "discounted_cash": 1013.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE CUTTER-STANDARD 391.905.99", "code_information": [{"code": "391.905.99", "type": "CDM"}], "standard_charges": [{"gross_charge": 2788.56, "discounted_cash": 1673.14, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE DRIVER 244CM NERVE MONITORING POWEREASE", "code_information": [{"code": "2344000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 189.6, "discounted_cash": 113.76, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE EKG 30IN LEAD CLIP CONVERSION MCKESSON", "code_information": [{"code": "545317-HEL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 214.88, "discounted_cash": 128.93, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE ELECTROSURGERY 10FT YELLOW MONOPOLAR TUR ENDO FOR ACMI LF STRL DISP", "code_information": [{"code": "60-2121-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.48, "discounted_cash": 11.09, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE EXTENSION 1 X 16 OR OPERATING ROOM PRECISION SPECTRA", "code_information": [{"code": "SC-4116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1425.6, "discounted_cash": 855.36, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE FIBER OPTIC BIFURCATED LUMITEX CLLAT 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"code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "GA185012B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8580.0, "discounted_cash": 5148.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 18MM X 45MM X 10MM 0DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XLB451000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12864.0, "discounted_cash": 7718.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 18MM X 50MM X 12MM 12 DEGREES 3LL1850-1212", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3LL1850-1212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9100.0, "discounted_cash": 5460.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 18MMX50MM7MM 7D LLIF SPACER GA185007B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GA185007B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8580.0, "discounted_cash": 5148.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 18X12X55 15 DEGREESE GA185512D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GA185512D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8580.0, "discounted_cash": 5148.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 19MM X 26MM X 34MM 8DEGREE 3135.0619", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3135.0619", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 19MM X 34MM X 26MM 15 DEGREE 3135.0719", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3135.0719", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 6600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 22MM WIDE X-LARGE 10degree 13MM 375.773CS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "375.773CS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8840.0, "discounted_cash": 5304.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 22MM WIDE X-SMALL 10 DEG 9MM 375.969CS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "375.969CS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8840.0, "discounted_cash": 5304.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 23 X 10MM BULLET  18-23100100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "18-23100100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12200.0, "discounted_cash": 7320.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 26MM STANDARD LORDOTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1773-06-126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7800.0, "discounted_cash": 4680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 26X10MM H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "18.131", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12870.0, "discounted_cash": 7722.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 27MM X 40MM X 18MM 3AS2740-2018", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2740-2018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10190.0, "discounted_cash": 6114.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 28 X 0 X 19MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3410-2814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12982.59, "discounted_cash": 7789.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 28X0X11MM ACCEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3410-2811", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12982.59, "discounted_cash": 7789.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 29 X 39 X 15MM 15 DEGREE 3135.1215", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3135.1215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 32 X 13 X 15 DEG ALIF PEEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ALIF1532-13P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10897.38, "discounted_cash": 6538.43, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 32 X 13 X 8 DEG ALIF PEEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ALIF0832-13P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13621.72, "discounted_cash": 8173.03, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 32X11X15 PEEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-3215-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11504.57, "discounted_cash": 6902.74, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 39X13X8 PEEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-C3908-13", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12800.0, "discounted_cash": 7680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 3D ANTERIOR LUMBAR 27MMX40MM 8 DEG 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2740-0814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6500.0, "discounted_cash": 3900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 3DP INTERFIXATED ALIF  8 X 34 X 24MM 20ADEG 1921010P2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1921010P2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11900.0, "discounted_cash": 7140.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 3DP INTERFIXATED ALIF 8X38X28MM 20 1921050P2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1921050P2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14300.0, "discounted_cash": 8580.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 3MM CAVUX CERVICAL  PD-31-203", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PD-31-203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4680.0, "discounted_cash": 2808.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 4 DEG 9 X 25MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48375094", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15973.82, "discounted_cash": 9584.29, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 4DEG 11MM X 25MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48395134", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12580.0, "discounted_cash": 7548.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 5030541 ANATOMIC PTC 14X11X5MM 5030541", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5030541", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 1680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 5030641 ANATOMIC PTC 14X11X6MM 5030641", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5030641", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 1680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 5030664 ANATOMIC PTC 16X14X6MM 5030664", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5030664", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 1680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 5030741 ANATOMIC PTC 14X11X7MM 5030741", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5030741", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2280.0, "discounted_cash": 1368.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 5030764 ANATOMIC PTC 16X14X7MM 5030764", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5030764", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 1680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 6 DEGREE 11M 22X50M TRANSCONTINENTAL TPS  375.351CS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "375.351CS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8840.0, "discounted_cash": 5304.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 60MM LEFT MAX TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "124222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 6MM ML ARTIFICIAL CERVICAL DISC CDM-635L CDM-635L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CDM-635L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12740.0, "discounted_cash": 7644.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 6MMX14MMX17MMX6 DEGREES  ANTERIOR CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48987066", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 1680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 7MMX14MMX17MMX6 DEGREES  ANTERIOR CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48987076", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 1680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 7X12X14X0DEG ANCHOR-C CAGE 48321070", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48321070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 8 DEG 15MM INDEPENDENCE MIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3135.0615", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 6600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 8 X 14 X 16MM 7DEGREE 3136.2108", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "3136.2108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7020.0, "discounted_cash": 4212.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 9 X 26 X 9.5-14 10 DEG EXPANDABLE BH092609D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "BH092609D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10400.0, "discounted_cash": 6240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 9MM X 7MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CSTS-MD0709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7800.0, "discounted_cash": 4680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 9X12X14X4DEG ANCHOR-C CAGE 48321094", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48321094", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE 9X14X16X4DEG ANCHOR-C CAGE 48323094", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48323094", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ACIF  PEEK 10 DEGREE X 7 MM ACIF10-07P", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ACIF10-07P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8995.35, "discounted_cash": 5397.21, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ACIF 39MM X 15MM X 15MM VAULT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "10-C3915-15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11200.0, "discounted_cash": 6720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ACIF 7MM X 5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ACIF-05-07P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8555.52, "discounted_cash": 5133.31, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE AERO AL LUMBAR 30  38MM  15MM  12 DEG. 48923052", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48923052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 11MM  30MM X 45MM 8DEG 3AS3045-0811", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS3045-0811", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10190.0, "discounted_cash": 6114.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 13MM 8 DEGREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2535-0813", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6500.0, "discounted_cash": 3900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 14MM 3AF2535-1514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2535-1514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6500.0, "discounted_cash": 3900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 14MM 8 DEGREE 3AF2535-0814", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2535-0814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6500.0, "discounted_cash": 3900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 15 DEGREE 39MM X 13MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ALIF1539-13P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13640.0, "discounted_cash": 8184.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 17MM M3 STAND ALONE 30MM X 45MM 15DEG 3AS3045-1517", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS3045-1517", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10190.0, "discounted_cash": 6114.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 22MM X 10MM X 45MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "23-EC2245-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11440.0, "discounted_cash": 6864.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 25 X 35 X 16MM 8 DEGREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2535-0816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6500.0, "discounted_cash": 3900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 27 X 40 X 12MM 8 DEGREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2740-0812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6500.0, "discounted_cash": 3900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 27 X 40 X 14MM 15 DEGREE 3AF2740-1514", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2740-1514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6500.0, "discounted_cash": 3900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 27MM X 40MM 15DEG 3AF2740-1516", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2740-1516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5720.0, "discounted_cash": 3432.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 27MM X 40MM X 14MM 3AS2740-2014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2740-2014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10190.0, "discounted_cash": 6114.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 32 X 26 X 15MM 8DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2-A-0003-4015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 32W 26L 11H 15DEG 02-A-0004-4011", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2-A-0004-4011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 38 X 28 X 15MM 15 DEG KA382815B", "code_information": [{"code": "C1713", "type": 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"2-A-0007-4015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 38W 26L 19H 15DEG 02-A-0006-4019", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2-A-0006-4019", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 38W X 26L X 13H 15DEG STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2-A-0006-4013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 38X26X15MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2-A-0006-4015", "type": "CDM"}, {"code": "278", "type": "RC"}], 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ALIF M3 STAND ALONE 16MM   25 X 35MM  20DEG 3AS2535-2016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2535-2016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10190.0, "discounted_cash": 6114.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF M3 STAND ALONE 25X35 15DEG 18MM 3AS2535-1518", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2535-1518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10190.0, "discounted_cash": 6114.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF M3 STAND-ALONE 25MM X 35MM  15DEG 3AS2535-1515", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2535-1515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10190.0, "discounted_cash": 6114.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE ALIF 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10190.0, "discounted_cash": 6114.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE STAND-ALONE M3 25MM X 35MM X 15 8 DEGREE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AS2535-0815", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10190.0, "discounted_cash": 6114.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SUSA 18 X 55 X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "23-EC1855-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11440.0, "discounted_cash": 6864.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SUSA 18 X 55 X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "23-EC1855-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11440.0, "discounted_cash": 6864.0, "setting": "both", "billing_class": 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5-21307-07", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5-21307-07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2240.0, "discounted_cash": 1344.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TI 18 X 55 X 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2185512LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11050.0, "discounted_cash": 6630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TI 18 X 55 X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2185514LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11050.0, "discounted_cash": 6630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE TI 18 X 60 X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2186010LL8-G2", 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"discounted_cash": 7.61, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA B  PEEK 685.111", "code_information": [{"code": "685.111", "type": "CDM"}], "standard_charges": [{"gross_charge": 680.96, "discounted_cash": 408.58, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA BLUNT ACCESS 18GA 2.5IN", "code_information": [{"code": "135-1825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.69, "discounted_cash": 17.81, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA BTTN 10MM X 3 CM SHLDR LOW PROFILE DUAL FLANGE DESIGN SILICONE PASSPORT", "code_information": [{"code": "AR-6592-10-30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.06, "discounted_cash": 101.44, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA BTTN 10MM X 4 CM SHLDR LOW PROFILE DUAL FLANGE DESIGN SILICONE PASSPORT", "code_information": [{"code": "AR-6592-10-40", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 144.31, "discounted_cash": 86.59, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA BTTN 10MM X 5 CM SHOULDER KNEE HIP ELBOW ORTHO FOR ARTHROSCOPIC SYS PASS", "code_information": [{"code": "AR-6592-10-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 144.31, "discounted_cash": 86.59, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA BTTN 8MM X 5 CM SHOULDER KNEE HIP ELBOW FOR ARTHROSCOPIC SYS PASSPORT SC", "code_information": [{"code": "AR-6592-08-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 191.36, "discounted_cash": 114.82, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA C  PEEK 685.112", "code_information": [{"code": "685.112", "type": "CDM"}], "standard_charges": [{"gross_charge": 680.96, "discounted_cash": 408.58, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA CURVED 10MM", "code_information": [{"code": "84-210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.94, "discounted_cash": 22.76, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA CURVED 12MM", "code_information": [{"code": "84-212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.94, "discounted_cash": 22.76, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA CURVED 14MM", "code_information": [{"code": "84-214", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.94, "discounted_cash": 22.76, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA CURVED 20GA 5MM TC 410 ACTIVE TIP DISP", "code_information": [{"code": "406-630-115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.92, "discounted_cash": 37.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA CURVED 8MM", "code_information": [{"code": "84-208", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.94, "discounted_cash": 22.76, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA D  PEEK 685.113", "code_information": [{"code": "685.113", "type": "CDM"}], "standard_charges": [{"gross_charge": 680.96, "discounted_cash": 408.58, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA DECLOTTING", "code_information": [{"code": "36861", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, 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"discounted_cash": 48.73, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA END DELIVERY ACCUPORT 15GA X 60MM", "code_information": [{"code": "308.151", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1263.5, "discounted_cash": 758.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA FLEXTIP .6MM 23GA X 32MM 1MM TIP", "code_information": [{"code": "3230 CAN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.22, "discounted_cash": 44.53, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA FLEXTIP .75MM 25G 3251", "code_information": [{"code": "3251", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 103.17, "discounted_cash": 61.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA FLOWPORT II 165MM OBTURATOR", "code_information": [{"code": "CAT02438", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 893.1, "discounted_cash": 535.86, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA GATEWAY 8 X 50  3910-080-050", "code_information": [{"code": "3910-080-050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 115.32, "discounted_cash": 69.19, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA GRAFT 149-4000", "code_information": [{"code": "149-4000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 752.78, "discounted_cash": 451.67, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA HIP 8.5MM X 110MM HIP ARTHROSCOPIC SURG FOR DISPOSABLE REPAIR KIT CLEAR-", "code_information": [{"code": "72200436", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.67, "discounted_cash": 76.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA HIP ARTHROSCOPY 8 X 120MM PRESERVATION SYSTEM", "code_information": [{"code": "HPS-CAN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 184.77, "discounted_cash": 110.86, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA HYDRODISECTION 23GA SMOOTH FLAT TIP", "code_information": [{"code": "AX14772", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.87, "discounted_cash": 15.52, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA HYDRODISSECTION 25G AX125037", "code_information": [{"code": "AX125037", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.01, "discounted_cash": 12.61, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA HYDRODISSECTION 25GA 1.57MM FROM BEND TO TIP AKAHOSHI ANT CHMBR OPHTHALM", "code_information": [{"code": "8065441820", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.54, "discounted_cash": 18.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA HYDRODISSECTION 25GA 8MM ANGL ANT CHMBR OPHTHALMIC STRL DISP", "code_information": [{"code": "8065441420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.72, "discounted_cash": 14.23, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA HYDRODISSECTION 27GA 1.57MM FROM BEND TO TIP AKAHOSHI ANT CHMBR OPHTHALM", "code_information": [{"code": "8065441920", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.11, "discounted_cash": 26.47, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA HYDRODISSECTION 27GA 8MM ANGL ANT CHMBR OPHTHALMIC STRL DISP", "code_information": [{"code": "8065441620", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.03, "discounted_cash": 16.82, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA IRRIGATING 27GA 4MM ANT CHMBR ANGL OPHTHALMIC STRL DISP", "code_information": [{"code": "8065420120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.65, "discounted_cash": 14.19, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA IRRIGATING 30GA X 4MM FROM BEND TO TIP ANT CHMBR", "code_information": [{"code": "8065420020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.65, "discounted_cash": 14.19, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA IVAS ACCESS 11G", "code_information": [{"code": "306-330-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 182.04, "discounted_cash": 109.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA LESION 20GA X 100MM 10MM V SHAPE ACTIVE TIP", "code_information": [{"code": "406-660-125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 141.73, "discounted_cash": 85.04, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA LIPOSUCTION 3MM 30CM TRIPORT LIPOSULPTOR DISP", "code_information": [{"code": "PAL-303LL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 142.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA LIPOSUCTION 3MM X 8MM 3PORT 22CM USABLE LEN TRI PORT III TIP STYLE FOR P", "code_information": [{"code": "PAL-303LS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 142.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA LIPOSUCTION 4MM 22CM TRIPORT LIPOSCULPTOR DISP", "code_information": [{"code": "PAL-403LS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 142.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA LIPOSUCTION 4MM 30MM MIRRORED LIPOSCULPTOR DISP", "code_information": [{"code": "PAL-406LL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 249.64, "discounted_cash": 149.78, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA LIPOSUCTION 4MM 30MM TRIPORT LIPOSCULPTOR DISP", "code_information": [{"code": "PAL-403LL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 249.64, "discounted_cash": 149.78, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA MEDLINE HUDSON RCI OXYGEN WITH ELASTIC HEAD STRAP PEDIATRIC 7' TUBING HUD1101", "code_information": [{"code": "HUD1101", "type": "CDM"}], "standard_charges": [{"gross_charge": 6.34, "discounted_cash": 3.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA MICROPICK 23GA X .60MM", "code_information": [{"code": "3229", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.22, "discounted_cash": 31.93, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA MONOPOLAR 100MM 20GA 10MM ACTIVE TIP CURVED RADIOFREQUENCY DISP", "code_information": [{"code": "406-630-125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.52, "discounted_cash": 54.91, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA NASAL 25FT TUBING UNIVERSAL CONNECTOR SOFTECH LF ADLT", "code_information": [{"code": "1824", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.35, "discounted_cash": 6.21, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA NASAL CO2 SAMPLING MALE LFADULT 10 FT", "code_information": [{"code": "HCS4568", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.36, "discounted_cash": 6.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA NASAL CONTOURED LIP TAB OVER THE EAR STYLE FLEXIBLE W/ 25FT STAR LUMEN T", "code_information": [{"code": "1812", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.67, "discounted_cash": 3.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA NASAL DIVIDED 7 FT O2 SUP TUBE MALE LUER ADULT", "code_information": [{"code": "4950-7-7-25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.53, "discounted_cash": 3.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA NASAL MALE LUER CONNECTOR W/ 7FT OXYGEN SAMPLE LINE SOFTECH", "code_information": [{"code": "1844", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.02, "discounted_cash": 14.41, "setting": "both", "billing_class": "facility"}]}, 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TENORRHAPY 28270", "code_information": [{"code": "28270", "type": "CPT"}, {"code": "1480239", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "gross_charge": 9512.0, "discounted_cash": 5707.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 5231.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULOTOMY WRIST 25085", "code_information": [{"code": "25085", "type": "CPT"}, {"code": "1480240", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ABLT RAD ARR CNV LOC MAP", "code_information": [{"code": "746T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ABLT RAD ARR N-INVAS LOC", "code_information": [{"code": "745T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ABLT RAD ARRHYT DLVR RAD", "code_information": [{"code": "747T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ACOUS WAVFRM REC CAD RSK", "code_information": [{"code": "716T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 1911.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNLPTHY GEN SEQ PNL", "code_information": [{"code": "237U", "type": "CPT"}], "standard_charges": [{"minimum": 1455.75, "maximum": 1712.76, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1712.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1455.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNNLPATH INC 10 GNS", "code_information": [{"code": "81413", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 757.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1521.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1521.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1601.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1441.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1073.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1712.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1455.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNNLPATH INC 2 GNS", "code_information": [{"code": "81414", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 757.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1521.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1521.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1601.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1441.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1073.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1712.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1455.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR OUTP MEAS DRG CATH CHD", "code_information": [{"code": "93598", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR-CAR BP GRFT/ENDOVAS TAA", "code_information": [{"code": "33891", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR-T CLL ADMN AUTOLOGOUS", "code_information": [{"code": "540T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARBACHOL OPTHALMIC 0.01% (MIOSTAT) 1.5ML", "code_information": [{"code": "MED0052", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 62.37, "discounted_cash": 37.42, "setting": "both", "billing_class": "facility"}]}, {"description": "CARD HRT TRNSPL 96 DNA SEQ", "code_information": [{"code": "55U", "type": "CPT"}], "standard_charges": [{"minimum": 8063.87, "maximum": 9487.53, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 9487.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8063.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARD MRI VELOC FLOW MAPPING", "code_information": [{"code": "75565", "type": "CPT"}], "standard_charges": [{"minimum": 1259.02, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1259.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2528.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2528.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2661.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2395.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1783.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARD MRI W/STRESS IMG & DYE", "code_information": [{"code": "75563", "type": "CPT"}], "standard_charges": [{"minimum": 1259.02, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1259.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2528.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2528.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2661.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2395.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1783.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [{"code": "297", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4788.62, "maximum": 7989.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7989.3, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4788.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [{"code": "296", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11270.57, "maximum": 18582.73, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 18582.73, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11270.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC", "code_information": [{"code": "298", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3541.55, "maximum": 5009.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5009.76, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 3541.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [{"code": "309", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5604.09, "maximum": 8385.14, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 8385.14, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5604.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [{"code": "308", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8834.42, "maximum": 13677.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13677.32, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8834.42, "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": 4127.28, "maximum": 6345.85, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6345.85, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4127.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [{"code": "306", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10340.59, "maximum": 16983.51, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 16983.51, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10340.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [{"code": "307", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6283.04, "maximum": 10507.23, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10507.23, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6283.04, "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": 41564.0, "maximum": 80153.91, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 80153.91, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 48899.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 46454.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 44009.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 41564.0, "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": 41564.0, "maximum": 70256.88, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 70256.88, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 48899.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 46454.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 44009.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 41564.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [{"code": "277", "type": "MS-DRG"}], "standard_charges": [{"minimum": 41564.0, "maximum": 52761.85, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 52761.85, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 48899.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 46454.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 44009.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 41564.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC DRUG STRESS TEST", "code_information": [{"code": "93024", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI FOR MORPH", "code_information": [{"code": "75557", "type": "CPT"}], "standard_charges": [{"minimum": 1097.5, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1097.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2204.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2204.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2320.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2088.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1554.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI FOR MORPH W/DYE", "code_information": [{"code": "75561", "type": "CPT"}], 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2395.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1783.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [{"code": "258", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16240.0, "maximum": 31819.98, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 31819.98, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 19855.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", 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"standard_charge_dollar": 26864.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 29293.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 15391.98, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 23195.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 22035.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 20876.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 19716.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER 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"standard_charge_dollar": 14619.81, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 23195.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 22035.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 20876.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 19716.0, "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": 16240.0, "maximum": 38633.12, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE 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"plan_name": "CIGNA DFW", "standard_charge_dollar": 31604.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 16240.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 26864.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 29293.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11970.81, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 23195.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 22035.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 20876.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 19716.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC REHAB", "code_information": [{"code": "93797", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC REHAB/MONITOR", "code_information": [{"code": "93798", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC SHUNT IMAGING", "code_information": [{"code": "78428", "type": "CPT"}], "standard_charges": [{"minimum": 348.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 348.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 698.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 698.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 735.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 662.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 492.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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{"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 46454.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 44009.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 41564.0, "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": 34236.0, "maximum": 73234.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 60075.17, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 41856.0, 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"AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 292.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 588.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 588.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 619.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 557.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 414.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 9487.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8063.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOPULM EXERCISE TESTING", "code_information": [{"code": "94621", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93015", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee 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charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93017", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVERSION ELECTRIC EXT", "code_information": [{"code": 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"plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE AFTER DELIVERY", "code_information": [{"code": "59430", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE MGMT SVC BHVL HLTH COND", "code_information": [{"code": "99484", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAREGIVER HEALTH RISK ASSMT", "code_information": [{"code": "96161", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAREGIVER TRAING 1ST 30 MIN", "code_information": [{"code": "97550", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAREGIVER TRAING EA ADDL 15", 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{"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10813.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 10212.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "36", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8412.0, "maximum": 25893.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 20791.02, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 10285.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 16372.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8412.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 13916.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 25893.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12668.84, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 12014.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11413.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10813.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee 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"standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARRIER GRAFT SKIN 1.5:1 DERMACARRIER II RATIO", "code_information": [{"code": "-2195-012-00", "type": "CDM"}, {"code": "272", "type": 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARS/BD TST INFT-12MO 60 MIN", "code_information": [{"code": "94780", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARTILAGINATOR LARGE CURVED CONVEX STERILE 170-01251-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "170-01251-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2296.0, "discounted_cash": 1377.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE ADVANCED CATARACT LENS SILVER SERIES", "code_information": [{"code": "PSCST30", "type": "CDM"}], "standard_charges": [{"gross_charge": 10.27, "discounted_cash": 6.16, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE DIAG TESTING I-STAT CELITE ACT HEMATOLOGY 50", "code_information": [{"code": "3P85-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.9, "discounted_cash": 26.94, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE EXOSHAPE 10MM X 30MM CANNULATED SLANT BACK", "code_information": [{"code": "1101-00-1030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1404.0, "discounted_cash": 842.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE EXOSHAPE 9MM X 30MM CANNULATED SLANT BACK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1101-00-0930", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3705.0, "discounted_cash": 2223.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE FLXFIT SD-15-FU", "code_information": [{"code": "SD-15-FU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1197.0, "discounted_cash": 718.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE I-STAT CHEM 8+", "code_information": [{"code": "9P31-25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 67.92, "discounted_cash": 40.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE I-STAT PT/NR", "code_information": [{"code": "3P89-24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.88, "discounted_cash": 17.93, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE IOL UNFOLDER EMERALD SERIES LOADING PLATFORM PREPOSITIONED WING INNER THERMOFORM TRAY", "code_information": [{"code": "EMERALDC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.5, "discounted_cash": 23.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE LUQUID", "code_information": [{"code": "85-003-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 174.72, "discounted_cash": 104.83, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE NDLINJECTOR II", "code_information": [{"code": "CAT01857", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 667.0, "discounted_cash": 400.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE STPL 60MM RELOAD LAP TROCAR ENDOPATH BLACK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GST60T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 454.75, "discounted_cash": 272.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE STPL 60MM STAPLER RELOAD LAP RETAINING ENDOPATH LF STRL DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ECR60B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 505.64, "discounted_cash": 303.38, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE STPLR 12MM 60MM GOLD LAP TROCAR RLD FOR ECHELON 60 ENDOPATH STAPLER EC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ECR60D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 450.74, "discounted_cash": 270.44, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE STPLR 12MM 60MM GRN LAP TROC RLD ECHELON ENDOPATH LF STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ECR60G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 450.74, "discounted_cash": 270.44, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE STPLR 30 X 3.5MM LINEAR CUTTER RELOAD TX LAPARASCOPIC PROXIMATE LF TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XR30B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 84.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE STPLR 60MM LINEAR CUTTER LAPARASCOPIC RELOAD TX PROXIMATE LF TI STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XR60G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 29.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE STPLR 60MM WHT RLD LAPARASCOPIC W/ ENDOCUTTER ECHELON ENDOPATH LF STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ECR60W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 487.38, "discounted_cash": 292.43, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE SUT BLACK COBRAID SHOULDER ARTHROSCOPY W/ MAGNUMWIRE SMARTSTITCH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OM-8077", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE SUT CO BRAID SHLDR W/ M CONNECTOR AND MAGNUMWIRE TENSILE STRENGTH SUT.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OM-8076", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE SUT ROTATOR CUFF POLYETHYLENE W/ OPUS MAGNUM WIRE SMARTSTICH DISP", "code_information": [{"code": "OM-8078", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.28, "discounted_cash": 252.17, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE SUT WHT SHLDR  M CONNECTOR ANDC MAGNUMWIRE UTLTRA HIGH TENSILE STREN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OM-8075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 825.0, "discounted_cash": 495.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE SUT WHT SHOUDLER MAGNUMWIRE ULTRA HIGH TENSILE STRENGTH SUT. COMPATIBL", "code_information": [{"code": "OM-8085", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 828.72, "discounted_cash": 497.23, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE SUTURE SPEEDSTICH MAGNUM WIRE BLACK CO=BRAID", "code_information": [{"code": "OM-8087", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 832.0, "discounted_cash": 499.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE VERTEPORT MANIFOLD 11GR DELIVERY", "code_information": [{"code": "605-411-500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 791.35, "discounted_cash": 474.81, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE WHT RELOAD F/ENDOCUTTER ECHEL GST60W", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "GST60W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 436.0, "discounted_cash": 261.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGEINSERTION W/ SOFT TIP SHEATH", "code_information": [{"code": "PSCST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.27, "discounted_cash": 6.16, "setting": "both", "billing_class": "facility"}]}, {"description": "CASCADIA GRAFT 12 X 45 X 22MM X 8DEG", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "6101-2224512LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11050.0, "discounted_cash": 6630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CASE MANAGEMENT", "code_information": [{"code": "T1016", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CASE MANAGEMENT, PER MONTH", "code_information": [{"code": "T2022", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CASPAR DISTR PIN18MMSTER FF909SB", "code_information": [{"code": "FF909SB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.09, "discounted_cash": 99.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CASSETTE CORE IRRIGATION", "code_information": [{"code": "5400050001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 141.97, "discounted_cash": 85.18, "setting": "both", "billing_class": "facility"}]}, {"description": "CASSETTE IRRIGATION HUMMMER CORE DISP", "code_information": [{"code": "5290-075-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.49, "discounted_cash": 72.29, "setting": "both", "billing_class": "facility"}]}, {"description": "CASSETTE NDL SHLDR FOR SPEEDSTITCH SUTURING DEV. REQUIRED FOR USAGE OF OM 7000 O", "code_information": [{"code": "OM-8850", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.05, "discounted_cash": 121.83, "setting": "both", "billing_class": "facility"}]}, {"description": "CAST PADDING 4YD X 4IN SPLINTING", "code_information": [{"code": "23626-540", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.85, "discounted_cash": 10.71, "setting": "both", "billing_class": "facility"}]}, {"description": "CAST PADDING 4YD X 6IN SPLINTING", "code_information": [{"code": "23626-560", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.92, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CATARACT PRE OP KIT DYKS1252B", "code_information": [{"code": "DYKS1252B", "type": "CDM"}], "standard_charges": [{"gross_charge": 66.24, "discounted_cash": 39.74, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH 2 WAY 5CC 20FR 0168L20H", "code_information": [{"code": "168L20H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.21, "discounted_cash": 25.93, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH 20FR 5CC 3 WAY", "code_information": [{"code": "119L20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.88, "discounted_cash": 30.53, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH 22FR 5CC 3 WAY", "code_information": [{"code": "119L22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.95, "discounted_cash": 26.37, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH 24 FR 5CC 3WAY", "code_information": [{"code": "119L24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.88, "discounted_cash": 30.53, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY 12FR 2W 5CC (REPL 0165SI12)", "code_information": [{"code": "175812", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.91, "discounted_cash": 11.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY 18FR30ML LATEX 3WAY LUBR 0167L18", "code_information": [{"code": "167L18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.45, "discounted_cash": 26.67, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY 22FR 3W 5CC ULTRAMER COATED (REPL PE722)", "code_information": [{"code": "KC2722", "type": "CDM"}], "standard_charges": [{"gross_charge": 58.05, "discounted_cash": 34.83, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY 8FR 2WAY 3CC PEDI SILICONE 165808", "code_information": [{"code": "165808", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.82, "discounted_cash": 10.09, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY COUNCIL 2-WAY 20FR 0196L20H", "code_information": [{"code": "196L20H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.54, "discounted_cash": 35.72, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY COUNCIL RD-LTX 18FR 5ML 0196L18", "code_information": [{"code": "196L18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.53, "discounted_cash": 31.52, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY KIT 16FR 5CC PTFE", "code_information": [{"code": "710016S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.38, "discounted_cash": 23.03, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY KIT 18FR 5CC PTFE", "code_information": [{"code": "710018S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.38, "discounted_cash": 23.03, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY KIT 20 FR", "code_information": [{"code": "710020S", "type": "CDM"}], "standard_charges": [{"gross_charge": 38.38, "discounted_cash": 23.03, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY KIT 22FR 5CC PTFE", "code_information": [{"code": "710022S", "type": "CDM"}], "standard_charges": [{"gross_charge": 38.38, "discounted_cash": 23.03, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY KIT 24 FR", "code_information": [{"code": "710024S", "type": "CDM"}], "standard_charges": [{"gross_charge": 38.38, "discounted_cash": 23.03, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY LUBRICATH STRL 12FR 5ML 0165L12", "code_information": [{"code": "165L12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.12, "discounted_cash": 25.87, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY LUBRICATH STRL 22FR 5ML 0165L22", "code_information": [{"code": "165L22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.96, "discounted_cash": 22.18, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY SILICONE 14FR 5CC", "code_information": [{"code": "175814", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 11.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLLOWER BARD 14FR 021112", "code_information": [{"code": "21112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.84, "discounted_cash": 32.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLLOWER BARD 16FR 021116", "code_information": [{"code": "21116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 134.24, "discounted_cash": 80.54, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLLOWER BARD 18FR 021118", "code_information": [{"code": "21118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.84, "discounted_cash": 32.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV SAFETY 16G X1.25 FEP STRGHT 4252586-02", "code_information": [{"code": "4252586-02", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 8.5, "discounted_cash": 5.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV SAFETY 20G X1 FEP STRAIGHT 4252543-02", "code_information": [{"code": "4252543-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.65, "discounted_cash": 5.19, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV SAFETY 20G X1.25 FEP STRGHT 4252535-02", "code_information": [{"code": "4252535-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.44, "discounted_cash": 5.06, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV SAFETY 20G X1.75 FEP STRGHT 4252527-02", "code_information": [{"code": "4252527-02", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 8.44, "discounted_cash": 5.06, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV SFTY INTROCAN 14 X 1 1/4", "code_information": [{"code": "4251890", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.92, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV SFTY INTROCAN 18GA X 1-1/4 TEF", "code_information": [{"code": "4252560", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.7, "discounted_cash": 23.82, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV SFTY INTROCAN 20GA X 1-1/4 TEF", "code_information": [{"code": "4252535", "type": "CDM"}], "standard_charges": [{"gross_charge": 9.73, "discounted_cash": 5.84, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV SFTY INTROCAN 22GA X 1 TEF", "code_information": [{"code": "4252519", "type": "CDM"}], "standard_charges": [{"gross_charge": 9.73, "discounted_cash": 5.84, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV SFTY INTROCAN 24GA  X 3/4", "code_information": [{"code": "4252500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.02, "discounted_cash": 6.01, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH KIT MULTI LUMEN MAX BARRIER STERILE", "code_information": [{"code": "CDC-45703-XP1A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 403.22, "discounted_cash": 241.93, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH LANGSTON DUAL LUMEN 6FR. 5540", "code_information": [{"code": "5540", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1944.0, "discounted_cash": 1166.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PLACE CARDIO BRACHYTX", "code_information": [{"code": "92974", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH STRAIGHT TIP 13.35\" 20FR HEYMAN FOLLOWERS DILATION  021120", "code_information": [{"code": "21120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.84, "discounted_cash": 32.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH STRAIGHT TIP 13.35\" 22FR HEYMAN FOLLOWERS DIALTION  021122", "code_information": [{"code": "21122", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.84, "discounted_cash": 32.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH SUPRA PUBIC 12FR X 20CM", "code_information": [{"code": "G26642", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 381.73, "discounted_cash": 229.04, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH SUPRA PUBIC 20FR X 17CM G26655", "code_information": [{"code": "G26655", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 381.73, "discounted_cash": 229.04, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH THORACIC ST 20FR X 20 INCH LONG", "code_information": [{"code": "570523", "type": "CDM"}], "standard_charges": [{"gross_charge": 77.66, "discounted_cash": 46.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH TROCAR 12FR 9\"L 8888561027", "code_information": [{"code": "8888561027", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 103.08, "discounted_cash": 61.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH TROCAR 16FR 10\"L 888561035", "code_information": [{"code": "888561035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.79, "discounted_cash": 53.87, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH TROCAR 28FR X 16 INCHL", "code_information": [{"code": "561068", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.66, "discounted_cash": 46.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH TROCAR 32FR X 16 INCHL", "code_information": [{"code": "561076", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.66, "discounted_cash": 46.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIAL CIR W/EMBOL", "code_information": [{"code": "C7515", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIAL CIR W/STENTS", "code_information": [{"code": "C7514", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIALCIR W/APLASTY", "code_information": [{"code": "C7513", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": 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"CATHETER BALLOON 0.75MM DIA", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "11583BP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 614.73, "discounted_cash": 368.84, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER BALLOON 7MM X 16MM SINUS DILATATION RELIEVA ULTIRRA ENDO", "code_information": [{"code": "BC0716RU", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2186.8, "discounted_cash": 1312.08, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER BALLOON DILATION 30FR X 15CM HIGH PRESSURE NEPHROSTOMY 20CM SHEATH", "code_information": [{"code": "M0062101440", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 624.14, "discounted_cash": 374.48, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER BALLOON DILATION UROMAX ULTRA HIGH PRESSURE 12FR X 10CM M0062251150", 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9.92, "discounted_cash": 5.95, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER CHOLANGIOGRAM 4.5FR 18IN OPERATIVE W/ METAL SUPPORT TUBE TAUT LF STRL", "code_information": [{"code": "20018-M55", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 115.44, "discounted_cash": 69.26, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER CONE 5FR 8FR CONE TIP URETHRAL TERMINOL CONE", "code_information": [{"code": "138008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.29, "discounted_cash": 26.57, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER COUDE 3 WAY 30 CC 20 FR 2557H20", "code_information": [{"code": "2557H20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.63, "discounted_cash": 44.18, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER COUVELAIRE TIP 3WAY 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{"code": "7726950", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 742.41, "discounted_cash": 445.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER DIALYSIS SWAN-NECK CURL LEFT 8888413807", "code_information": [{"code": "8888413807", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 455.23, "discounted_cash": 273.14, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER DIL 18FR 4 CM 5.8FR 75 CM .038IN BLLN HIGH PRESSURE W/ HYDROPLUS COATIN", "code_information": [{"code": "M0062251020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 549.0, "discounted_cash": 329.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER DILATATION 5IN X 5.8FR X 75 CM 10CC U2Q LIWG KIT UROMAX ULTRA", "code_information": [{"code": "225136", "type": "CDM"}], "standard_charges": [{"gross_charge": 730.7, "discounted_cash": 438.42, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER DILATION 10 X 40MM INSPIRA AIR SINUPLASTY SYSTEM", "code_information": [{"code": "BC1040A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1501.2, "discounted_cash": 900.72, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER DRAIN 14 FR MALECOT FOUR WING LATEX DISP", "code_information": [{"code": "86014", "type": "CDM"}], "standard_charges": [{"gross_charge": 14.78, "discounted_cash": 8.87, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER DRAIN 14 FR MALECOT FOUR WING LATEX DISP", "code_information": [{"code": "86014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.52, "discounted_cash": 5.71, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER DUPLOCATH APPLICATION 35CM 1506166", "code_information": [{"code": "1506166", 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{"description": "CEMENT BONE PALACOS PRO R 80GM 5081287", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5081287", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 681.0, "discounted_cash": 408.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE PALACOS R+G HIGH-VISCOSITY W/GENTAMICIN 40GM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5036964", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 518.85, "discounted_cash": 311.31, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE R BIOMET 1X40", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110035368", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 289.55, "discounted_cash": 173.73, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE R REFOBACIN 1X40 WITH GENTAMICIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "110034355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 302.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE RALLY 40G HIGH VISCOSITY ANTIBIOTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71271570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 816.0, "discounted_cash": 489.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE SIMPLEX HV 6194-1-001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6194-1-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE SMARTSET 40G HIGH VISCOSITY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5450-35-500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 957.0, "discounted_cash": 574.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE W/ KYPHOLON MIXER KYPHX HV R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "C01B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 544.22, "discounted_cash": 326.53, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE W/ MIXER XPEDE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CX01B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 639.18, "discounted_cash": 383.51, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT CARTRIDGE KYPHON CDS", "code_information": [{"code": "CC02A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.72, "discounted_cash": 190.03, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT FEMORAL SZ 2 PATELLO JOINT SYS LFT SIDE PRECOAT GENDER SOLS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "-5926-012-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9100.0, "discounted_cash": 5460.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT FEMORAL SZ 3 PATELLO JOINT SYS PREOCAT RIGHT SIDE GENDER SOLS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "-5926-013-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11874.31, "discounted_cash": 7124.59, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT FEMORAL SZ 4 PATELLO JOINT SYS PRECOAT LFT SIDE GENDER SOLS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "-5926-014-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11890.24, "discounted_cash": 7134.14, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT FEMORAL SZ 4 PATELLO JOINT SYS PRECOAT RIGHT SIDE GENDER SOLS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-5926-014-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11890.24, "discounted_cash": 7134.14, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT FEMORAL SZ 5 PATELLO JOINT SYS PRECOAT RIGHT SIDE GENDER SOLS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "-5926-015-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9100.0, "discounted_cash": 5460.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT FORTRESS PLUS 4129.2020S 4129.2020S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4129.2020S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 264.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT GUN KYPHON BONE FILLER SIZE 2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CDS2A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 796.5, "discounted_cash": 477.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT MIXING SPATULA 210088", "code_information": [{"code": "210088", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.76, "discounted_cash": 20.26, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT PRESSURIZER PRZ-01", "code_information": [{"code": "PRZ-01", "type": "CDM"}], "standard_charges": [{"gross_charge": 93.6, "discounted_cash": 56.16, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT PUSHER 5.0-5.8MM", "code_information": [{"code": "909-300-500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 223.89, "discounted_cash": 134.33, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT RESTRICTOR 10MM BIOSTOP BIORESORBABLE", "code_information": [{"code": "5463-10-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 389.28, "discounted_cash": 233.57, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT RESTRICTOR LARGE TPA-24", "code_information": [{"code": "TPA-24", "type": "CDM"}], "standard_charges": [{"gross_charge": 197.6, "discounted_cash": 118.56, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT RESTRICTOR SIZE 4 15.75MM 5460-16-000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5460-16-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 684.0, "discounted_cash": 410.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT RESTRICTOR SIZE 5 18.25MM 5460-18-000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5460-18-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 684.0, "discounted_cash": 410.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT RESTRICTOR XXS EXTRA  EXTRA SMALL SZ8 TPA-8", "code_information": [{"code": "TPA-8", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 197.6, "discounted_cash": 118.56, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT SPATULA/RING CURETTE 5461-30-000", "code_information": [{"code": "5461-30-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.64, "discounted_cash": 102.38, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT SYSTEM HIGH V+ SPINAL  T040321K", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "T040321K", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4547.4, "discounted_cash": 2728.44, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT VERTEPORT MANIFOLD ASSIST 10GR", "code_information": [{"code": "605-410-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 925.79, "discounted_cash": 555.47, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMEX GUN SILICON SHOCK ABSORBER ASA0140", "code_information": [{"code": "ASA0140", "type": "CDM"}], "standard_charges": [{"gross_charge": 30.8, "discounted_cash": 18.48, "setting": "both", "billing_class": "facility"}]}, {"description": "CENTRALIZER DIST 11MM TYPE A MODIFIED", "code_information": [{"code": "6265-4-411", "type": "CDM"}], "standard_charges": [{"gross_charge": 333.7, "discounted_cash": 200.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CENTRALIZER DIST 13MM TYPE A MODIFIED", "code_information": [{"code": "6265-4-413", "type": "CDM"}], "standard_charges": [{"gross_charge": 333.7, "discounted_cash": 200.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CENTRALIZER DIST 16MM TYPE A MODIFIED", "code_information": [{"code": "6265-4-416", "type": "CDM"}], "standard_charges": [{"gross_charge": 333.7, "discounted_cash": 200.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CENTRALIZER DIST 16MM TYPE B MODIFIED", "code_information": [{"code": "6265-4-516", "type": "CDM"}], "standard_charges": [{"gross_charge": 333.7, "discounted_cash": 200.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CENTRALIZER DIST 17MM TYPE A MODIFIED", "code_information": [{"code": "6265-4-417", "type": "CDM"}], "standard_charges": [{"gross_charge": 333.7, "discounted_cash": 200.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CENTRALIZER DIST 17MM TYPE B MODIFIED", "code_information": [{"code": "6265-4-517", "type": "CDM"}], "standard_charges": [{"gross_charge": 333.7, "discounted_cash": 200.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CENTRALIZER DIST 18MM TYPE A MODIFIED", "code_information": [{"code": "6265-4-418", "type": "CDM"}], "standard_charges": [{"gross_charge": 333.7, "discounted_cash": 200.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CENTRALIZER DIST 18MM TYPE B MODIFIED", "code_information": [{"code": "6265-4-518", "type": "CDM"}], "standard_charges": [{"gross_charge": 333.7, "discounted_cash": 200.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CENTRALIZER DIST 19MM TYPE B MODIFIED", "code_information": [{"code": "6265-4-519", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 333.7, "discounted_cash": 200.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CENTRALIZER DIST 21MM TYPE B MODIFIED", "code_information": [{"code": "6265-4-521", "type": "CDM"}], "standard_charges": [{"gross_charge": 333.7, "discounted_cash": 200.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CEP72 NUDT15&TPMT GENE ALYS", "code_information": [{"code": "286U", "type": "CPT"}], "standard_charges": [{"minimum": 333.81, "maximum": 392.75, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 392.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 333.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEQUENCE  MOD TAP II  4.0MM 0257-1040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "257-1040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 443.69, "discounted_cash": 266.21, "setting": "both", "billing_class": "facility"}]}, {"description": "CERAMENT BONE VOID FILLER 5ML", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A0210-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3627.0, "discounted_cash": 2176.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CERCLAGE OF CERVIX NONOBSTETRICAL 57700", "code_information": [{"code": "57700", "type": "CPT"}, {"code": "1480248", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEREBROSPINAL FLUID SCAN", "code_information": [{"code": "78630", "type": "CPT"}], "standard_charges": [{"minimum": 979.82, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 979.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1967.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1967.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, 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"plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 24717.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 35308.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 36778.54, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 21343.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 20276.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 19209.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 18142.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CERVICAL SPINAL FUSION WITHOUT CC/MCC", "code_information": [{"code": "473", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14942.0, "maximum": 35308.0, "estimated_discounted_cash": 34512.26, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 26851.05, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 18268.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 29079.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 14942.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 24717.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 35308.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 17417.09, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 21343.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 20276.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 19209.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 18142.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CERVICAL SYSTEM 5MM RIGHT OFFSET HOOK 04-05ROH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4-05ROH", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2923.7, "discounted_cash": 1754.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL SYSTEM 5MM STANDARD HOOK 04-05STH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4-05STH", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2923.7, "discounted_cash": 1754.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL SYSTEM 6MM LEFT OFFSET HOOK 04-06LOH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4-06LOH", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2923.7, "discounted_cash": 1754.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL SYSTEM 6MM RIGHT OFFSET HOOK 04-06ROH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4-06ROH", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2923.7, "discounted_cash": 1754.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL SYSTEM 6MM STRAIGHT HOOK 04-06STH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4-06STH", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2923.7, "discounted_cash": 1754.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL SYSTEM HOOK 5MM LEFT OFFSET HOOK 04-05LOH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4-05LOH", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2923.7, "discounted_cash": 1754.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL VISUALIZATION HARNESS", "code_information": [{"code": "PD-33-600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 363.4, "discounted_cash": 218.04, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICOPLASTY 15819", "code_information": [{"code": "15819", "type": "CPT"}, {"code": "1954824", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVIVE DRIVER CD102013", "code_information": [{"code": "CD102013", "type": "CDM"}], "standard_charges": [{"gross_charge": 300.83, "discounted_cash": 180.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CESAREAN DELIVERY", "code_information": [{"code": "59510", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CESAREAN DELIVERY", "code_information": [{"code": "59515", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CESAREAN DELIVERY ONLY", "code_information": [{"code": "59514", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [{"code": "784", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14555.52, "maximum": 23590.99, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14555.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 19970.52, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 22411.6, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 23590.99, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 21232.22, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 15806.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [{"code": "783", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24757.82, "maximum": 40126.46, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 24757.82, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 33968.32, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 38120.42, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 40126.46, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 36114.37, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 26885.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC", "code_information": [{"code": "785", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11739.84, "maximum": 19027.45, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11739.84, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 16107.34, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18076.21, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 19027.45, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17124.97, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12748.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [{"code": "787", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14270.59, "maximum": 23129.19, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14270.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 19579.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 21972.89, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 23129.19, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 20816.59, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 15496.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [{"code": "786", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21717.7, "maximum": 35199.15, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21717.7, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 29797.2, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 33439.43, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 35199.15, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 31679.72, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 23584.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC", "code_information": [{"code": "788", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12159.17, "maximum": 19707.08, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 12159.17, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 16682.67, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18721.86, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 19707.08, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17736.64, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1547.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3108.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3108.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3271.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2944.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1461.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1241.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR GENE INTRON POLY T", "code_information": [{"code": "81224", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, 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"standard_charge_dollar": 494.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81221", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 378.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 759.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 759.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 799.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 719.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 535.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 284.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 241.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHAIR BEACH 100IN X 172IN BLUE FENESTRATED ORTHO DRP ADHSV PLYPRPLN WITHOUT COVE", "code_information": [{"code": "89066", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 123.24, "discounted_cash": 73.94, 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE G-TUBE TO G-J PERC", "code_information": [{"code": "49446", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE GASTRIC PORT OPEN", "code_information": [{"code": "43888", "type": "CPT"}], "standard_charges": [{"minimum": 3303.0, "maximum": 16760.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3330.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4892.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6688.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6336.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4717.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 10820.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 16760.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8850.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 14246.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16095.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE NEPHROURETERAL CATH", "code_information": [{"code": "50387", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE OF CYSTOSTOMY TUBE COMPLICATED 51710", "code_information": [{"code": "51710", "type": "CPT"}, {"code": "2334780", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1420.1, "maximum": 8427.0, "gross_charge": 2582.0, "discounted_cash": 1549.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1420.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE OF CYSTOSTOMY TUBE SIMPLE 51705", "code_information": [{"code": "51705", "type": "CPT"}, {"code": "42604688", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE OF URETER TUBE/STENT", "code_information": [{"code": "50688", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE URETER STENT PERCUT", "code_information": [{"code": "50382", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGER TRACH TUBE 7.0MM", "code_information": [{"code": "9-0202-70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.15, "discounted_cash": 32.49, "setting": "both", "billing_class": "facility"}]}, {"description": "CHANNEL 900-501 WORKING REMOVER 900-501", "code_information": [{"code": "900-501", "type": "CDM"}], "standard_charges": [{"gross_charge": 1148.85, "discounted_cash": 689.31, "setting": "both", "billing_class": "facility"}]}, {"description": "CHARGING SYSTEM PRODIGY NEURO STIMULATOR", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8567.0, "discounted_cash": 5140.2, "setting": "both", 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"plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IA INFUSION UP TO 1 HR", "code_information": [{"code": "96422", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, 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SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO INTRALESIONAL OVER 7", "code_information": [{"code": "96406", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO INTRALESIONAL UP TO 7", "code_information": [{"code": "96405", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV INFUS EACH ADDL SEQ", "code_information": [{"code": "96417", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV INFUSION 1 HR", "code_information": [{"code": "96413", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV INFUSION ADDL HR", "code_information": [{"code": "96415", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV PUSH ADDL DRUG", "code_information": [{"code": "96411", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV PUSH SNGL DRUG", "code_information": [{"code": "96409", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO PROLONG INFUSE W/PUMP", "code_information": [{"code": "96416", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 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"plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREM 1-4 EA", "code_information": [{"code": "64643", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": 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"code_information": [{"code": "64642", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ADDUCT VOCAL", "code_information": [{"code": "S2341", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ECCRINE GLANDS", "code_information": [{"code": "64653", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV TRUNK MUSC 6/>", "code_information": [{"code": "64647", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION ANAL MUSC", "code_information": [{"code": "46505", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF ABDUCTOR", "code_information": [{"code": "S2340", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF EXTRAOCULAR MUSCLE 67345", "code_information": [{"code": "67345", "type": "CPT"}, {"code": "1480256", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee 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"plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF MUSCLE(S);EXTREMITY(S) AND/OR TRUNK MUSCLE(S) 64614", "code_information": [{"code": "1480258", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF MUSCLE(S);NECK MUSCLE(S) 64613", "code_information": [{"code": "1480260", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF MUSCLE; MUSCLE INNERVATED BY FACIAL/ TRIGEMINAL/CERVICAL SPINAL 64615", "code_information": [{"code": "64615", "type": "CPT"}, {"code": "20535011", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF MUSCLE; NECK MUSCLES; UNILATERAL 64616", "code_information": [{"code": "64616", "type": "CPT"}, {"code": "18370561", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF ONE EXTREMITY; 5 OR MORE MUSCLES 64644", "code_information": [{"code": "64644", "type": "CPT"}, {"code": "18370595", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 1534.0, "discounted_cash": 920.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF TRUNK MUSCLES; 1-5 MUSCLES 64646", "code_information": [{"code": "64646", "type": "CPT"}, {"code": "18370603", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTAXIS ASSAY", "code_information": [{"code": "86155", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 262.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 262.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 276.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 249.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 185.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 46.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 39.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY DRUG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY INFUSION METHOD", "code_information": [{"code": "96425", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 232.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 466.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 466.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 491.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 442.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 329.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 125.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 106.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLMYD TRACH AG IA", "code_information": [{"code": "87320", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 43.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 37.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLMYD TRACH ASSAY W/OPTIC", "code_information": [{"code": "87810", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 98.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 197.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 197.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 156.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 133.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLORAMBUCIL 2 MG", "code_information": [{"code": "S0172", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLORHEXIDINE GLUCONATE 2% 118ML SCRUB (MEDID)", "code_information": [{"code": "MED0717", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.76, "discounted_cash": 5.86, "setting": "both", "billing_class": "facility"}]}, {"description": "CHLORHEXIDINE GLUCONATE ORAL 0.12%/480ML ORAL RINSE", 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"discounted_cash": 721.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CHMOTX ADMN PLRL CAV THRCNTS", "code_information": [{"code": "96440", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 232.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 208.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 155.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 98.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 83.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME STUDY ADDITIONAL", "code_information": [{"code": "88289", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 281.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 5358.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [{"code": "191", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6708.03, "maximum": 9743.91, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9743.91, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6708.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [{"code": "190", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8739.74, "maximum": 12737.07, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 12737.07, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8739.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC", "code_information": [{"code": "192", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5314.89, "maximum": 7340.54, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7340.54, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5314.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHRONOS PHOSPHATE GRANULES 5CC***CONSIGNMENT***", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "710.025.97S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1300.71, "discounted_cash": 780.43, "setting": "both", "billing_class": "facility"}]}, {"description": "CILLIARY BODY DESTRUCTION;CRYOTHERAPY 66720", "code_information": [{"code": "66720", "type": "CPT"}, {"code": "1480270", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CILLIARY BODY DESTRUCTION;CYCLOPHOTOCOAGULATION TRANSSCLERAL 66710", "code_information": [{"code": "66710", "type": "CPT"}, {"code": "1480272", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CINCH KNEE MENISCAL CURVED TIP W/ LOW PROFILE PEEK IMPLANTS W/ PRETIED 2-0 FIBER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4500", "type": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 771.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 812.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 730.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 544.11, "methodology": "fee 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payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 371.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 746.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 746.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 785.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 707.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 526.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIPRODEX 7.5ML OTIC", "code_information": [{"code": "MED0062", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 570.44, "discounted_cash": 342.26, "setting": "both", "billing_class": "facility"}]}, {"description": "CIPROFLOXACIN/CILOXAN OPHTHALMIC", "code_information": [{"code": "MED0060", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.02, "discounted_cash": 6.61, "setting": "both", "billing_class": "facility"}]}, {"description": "CIPROFLOXACIN/DEXAMETHASONE (CIPRODEX) OTIC 7.5ML", "code_information": [{"code": "MED0061", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 570.44, "discounted_cash": 342.26, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT ANESTHESIA 72IN 3LT BAG BREATHING UNIVERSAL FLEX 2 ADLT", "code_information": [{"code": "DF375-6121Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.94, "discounted_cash": 17.36, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT ANESTHESIA ADULT LF", "code_information": [{"code": "DYNJAAF6410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.97, "discounted_cash": 26.98, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT BREATHING 39IN UNIVERSALINTERMITTENT POSITIVE PRESSURE BREATHING SNGL LI", "code_information": [{"code": "1560", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.32, "discounted_cash": 7.99, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT BREATHING 70IN UNIVSL SNGL LIMB ANES W/ FILTER AND 2L BAG MASK AND SAMPL", "code_information": [{"code": "DF475V-6121Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.48, "discounted_cash": 21.29, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT BREATHING JACKSON REESE", "code_information": [{"code": "3731K-366WS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.57, "discounted_cash": 29.14, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT GAS SAMPLING LINE 0.05\"  7066", "code_information": [{"code": "7066", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.93, "discounted_cash": 2.96, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT UNIVERSAL FLEX2 DF475-6121Z", "code_information": [{"code": "DF475-6121Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.73, "discounted_cash": 17.84, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [{"code": "286", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7970.0, "maximum": 25103.25, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 25103.25, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9743.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15508.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 7970.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 13182.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 15303.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16007.07, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 11382.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 10813.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10244.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 9675.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [{"code": "287", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7970.0, "maximum": 15508.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 12359.38, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9743.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15508.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 7970.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 13182.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 15303.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8359.53, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 11382.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 10813.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10244.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 9675.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRCUMCISION NEONATE", "code_information": [{"code": "54160", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CIRCUMCISION W/REGIONL BLOCK", "code_information": [{"code": "54150", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CIRCUMCISION-SURGICAL EXCISION-OLDER THAN 28 DAYS 54161", "code_information": [{"code": "54161", "type": "CPT"}, {"code": "1480274", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [{"code": "433", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7544.79, "maximum": 12133.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 12133.67, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7544.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [{"code": "432", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13402.84, "maximum": 22220.11, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 22220.11, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13402.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC", "code_information": [{"code": "434", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4779.07, "maximum": 7899.7, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7899.7, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4779.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CISTERNAL OR LATERAL CERVICAL PUNCTURE; WITH INJECTION OR MEDICATION FOR TREATMENT 61055", "code_information": [{"code": "61055", "type": "CPT"}, {"code": "4240126", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CKMB", "code_information": [{"code": "82553", "type": "CPT"}, {"code": "1221822", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "gross_charge": 402.0, "discounted_cash": 241.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 96.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 193.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 193.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", 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347.93, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEAR EYELID GLAND W/HEAT", "code_information": [{"code": "207T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 3989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.28, "discounted_cash": 3.77, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING SM PILLING TANTALUM", "code_information": [{"code": "W523100", "type": "CDM"}], "standard_charges": [{"gross_charge": 57.9, "discounted_cash": 34.74, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING SM YELLOW SURG GRADE TANTALUM HEMOCLIP", "code_information": [{"code": "A4649", "type": "HCPCS"}, {"code": "523135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.8, "discounted_cash": 18.48, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LOCKING ANKLE SZ 2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "350-10-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 636.0, "discounted_cash": 381.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP MMG STIM MULTI STAGE 2862-02-204", "code_information": [{"code": "2862-02-204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 545.3, "discounted_cash": 327.18, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP RANEY SCALP DISP 10/PK", "code_information": [{"code": "20-1037", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.34, "discounted_cash": 3.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP REPLACE 75CM 30IN WHT LEADWIRE 300 SERIES", "code_information": [{"code": "545359", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.6, "discounted_cash": 56.16, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP SCALP RANEY", "code_information": [{"code": "57-8501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.43, "discounted_cash": 3.86, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP STIMULATING SAFE OP AIX1310-S", "code_information": [{"code": "AIX1310-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 899.08, "discounted_cash": 539.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP STIMULATION M5INLINE ACTIVATOR SURG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2012022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1263.5, "discounted_cash": 758.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP SUTURE ENDO ABS 2-0/3-0/4-0 VICRYL XC200", "code_information": [{"code": "XC200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.21, "discounted_cash": 300.13, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP VLOCK LARGE PURPLE 6/CTG 61114V", "code_information": [{"code": "61114V", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 134.31, "discounted_cash": 80.59, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP VLOCK MEDIUM LARGE GREEN 6/CTG 51114V", "code_information": [{"code": "51114V", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 121.83, "discounted_cash": 73.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CLONIDINE 0.1 MG TABLET", "code_information": [{"code": "MED0502", "type": "CDM"}], "standard_charges": [{"gross_charge": 0.3, "discounted_cash": 0.18, "setting": "both", "billing_class": "facility"}]}, {"description": "CLONIDINE 100 MCG/ML INTRATHECAL SOL 10 ML", "code_information": [{"code": "MED0687", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 84.41, "discounted_cash": 50.65, "setting": "both", "billing_class": "facility"}]}, {"description": "CLORPACTIN WCS-90 TOPICAL POWDER", "code_information": [{"code": "MED0559", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 30.81, "discounted_cash": 18.49, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOSE BLADDER-UTERUS FISTULA", "code_information": [{"code": "51920", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE BRONCHIAL FISTULA", "code_information": [{"code": "32815", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE CHEST AFTER DRAINAGE", "code_information": [{"code": "32810", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE KIDNEY-SKIN FISTULA", "code_information": [{"code": "50520", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE MASTOID FISTULA", "code_information": [{"code": "69700", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE MULT VSD", "code_information": [{"code": "33675", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE MULT VSD W/RESECTION", "code_information": [{"code": "33676", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE NEPHROVISCERAL FISTULA", "code_information": [{"code": "50525", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR SYSTEM FISTULA", "code_information": [{"code": "68770", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": 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"case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION ACROMIOCLAVICULAR DISLOCATION W/O MANIPULATION 23540", "code_information": [{"code": "23540", "type": "CPT"}, {"code": "1480278", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": 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"BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED REDUCTION CARPAL BONE W/ MANIPULATION 26742", "code_information": [{"code": "26742", "type": "CPT"}, {"code": "1480280", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF SALIVARY FISTULA", "code_information": [{"code": "42600", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", 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"standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 161.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 323.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 323.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 340.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 306.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 228.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 44.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 38.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT INHIBIT PROT S TOTAL", "code_information": [{"code": "85305", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 137.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 276.83, "methodology": "fee 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 34.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 28.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOTH SKIN PREPARATION 7.5IN X 7.5IN 2 PCT ALCOHOL FREE PRE OPERATIVE CHLORHEXID", "code_information": [{"code": "SGE9705", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.67, "discounted_cash": 5.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOTTING ASSAY WHOLE BLOOD", "code_information": [{"code": "85396", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"CIGNA DFW", "standard_charge_dollar": 56.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 48.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOTTING FUNCT ACTIVITY", "code_information": [{"code": "85397", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 70.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 141.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 141.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 148.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 133.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 99.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 90.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 76.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOZAPINE, 25 MG", "code_information": [{"code": "S0136", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLSD TX PELVIC RING FX", "code_information": [{"code": "27197", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF 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1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX CLAVICULAR FX W/MNPJ", "code_information": [{"code": "23505", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX GR HMRL TBRS FX WO MNPJ", "code_information": [{"code": "23620", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX MEDIAL ANKLE FX", "code_information": [{"code": "27760", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX POST ANKLE FX", "code_information": [{"code": "27767", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX POST ANKLE FX W/MNPJ", "code_information": [{"code": "27768", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX PROX HUMRL FX W/O MNPJ", "code_information": [{"code": "23600", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX PRX HMRL FX MNPJ+-TRACT", "code_information": [{"code": "23605", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX SCAP FX W/MNPJ +-TRACTJ", "code_information": [{"code": "23575", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX SCAPULAR FX W/O MNPJ", "code_information": [{"code": "23570", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DISLC NECK FX MNPJ", "code_information": [{"code": "23675", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DSLC FX GR HMRL TBR", "code_information": [{"code": "23665", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX STRNCLAV DISLC W/MNPJ", "code_information": [{"code": "23525", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX STRNCLAV DISLC W/O MNPJ", "code_information": [{"code": "23520", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX THIGH FX", "code_information": [{"code": "27267", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX THIGH FX W/MNPJ", "code_information": [{"code": "27268", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ABLATION", "code_information": [{"code": "45388", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE 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"plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/DECOMPRESSION", "code_information": [{"code": "45393", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case 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"standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ENDOSCOPE US", "code_information": [{"code": "45391", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF 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billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/INJECTION", "code_information": [{"code": "44404", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO 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6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/NDL ASPIR/BX", "code_information": [{"code": "44407", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/RESECTION", "code_information": [{"code": "44403", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/RESECTION", "code_information": [{"code": "45390", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/STENT PLCMT", "code_information": [{"code": "44402", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/STENT PLCMT", "code_information": [{"code": "45389", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ULTRASOUND", "code_information": [{"code": "44406", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY WITH ABLATION", "code_information": [{"code": "44401", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLOSTOMY WITH BIOPSIES", "code_information": [{"code": "44322", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOCENTESIS 57020", "code_information": [{"code": "57020", "type": "CPT"}, {"code": "1480403", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOCLEISIS (LE FORT TYPE) 57120", "code_information": 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"both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLPOPEXY ABDOMINAL APPROACH 57280", "code_information": [{"code": "57280", "type": "CPT"}, {"code": "1480406", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLUMBUS UC GLIDING SURFACE T2/2+ 10MM NN420", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "NN420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3400.77, "discounted_cash": 2040.46, "setting": "both", "billing_class": "facility"}]}, {"description": "COLUMBUS UC GLIDING SURFACE T2/2+ 12MM NN421", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "NN421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3400.77, "discounted_cash": 2040.46, 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"standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPL ZIFT CASE RATE", "code_information": [{"code": "S4014", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 75.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 150.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 150.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 158.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 29.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 24.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT TOTAL (CH50)", "code_information": [{"code": "86162", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 35.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 29.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLETE IVF NOS CASE RATE", "code_information": [{"code": "S4015", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, 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SOLUTIONS", "standard_charge_dollar": 330.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSLTJ&REPRT SLD PREP ELSWR", "code_information": [{"code": "88321", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 78.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 156.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 156.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 164.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 148.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 110.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 243.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 206.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTELLATION GFI ADMIN TUBING", "code_information": [{"code": "8065750920", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.22, "discounted_cash": 96.73, "setting": "both", "billing_class": "facility"}]}, {"description": "CONSTELLATION LOCKING CAP DRIVER FOR PANGEA 03.616.021", "code_information": [{"code": "3.616.021", "type": "CDM"}], "standard_charges": [{"gross_charge": 2360.88, "discounted_cash": 1416.53, "setting": "both", "billing_class": "facility"}]}, {"description": "CONSTELLATION TOTAL PLUS PAK 23G W/VALVE", "code_information": [{"code": "8065751900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1423.44, "discounted_cash": 854.06, "setting": "both", "billing_class": "facility"}]}, {"description": "CONSTRUCT BOWEL BLADDER", "code_information": [{"code": "50820", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT BOWEL BLADDER", "code_information": [{"code": "50825", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee 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"CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT THUMB REPLACEMENT", "code_information": [{"code": "26550", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT VAGINA WITH GRAFT", "code_information": [{"code": "57292", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46730", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee 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"CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46735", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46740", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 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[{"code": "13594-130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.1, "discounted_cash": 0.66, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTAINER SPECIMEN 6OZ URINALYSIS POURING SPOUT POLYSTYRENE LF", "code_information": [{"code": "DYND30100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.55, "discounted_cash": 0.33, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTAINER W/LID RCRA DISPOSABLE 8617RC-BKC", "code_information": [{"code": "8617RC-BKC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.22, "discounted_cash": 59.53, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTINUOUS INTRAOP NEUROPHYSIOLOGY MONITORING IN THE O.R. 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRAST EXAM ABDOMINL AORTA", "code_information": [{"code": "75625", "type": "CPT"}], "standard_charges": 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"standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1384.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2781.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2781.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1384.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2781.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2781.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2927.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2634.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1961.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST 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schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2862.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2576.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1918.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 22498.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 19122.79, "methodology": "fee schedule"}], "billing_class": 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DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF BRAIN", "code_information": [{"code": "70010", "type": "CPT"}], "standard_charges": [{"minimum": 1116.45, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1116.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2242.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2242.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2360.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2124.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1581.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1612.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1370.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF BRAIN", "code_information": [{"code": "70015", "type": "CPT"}], "standard_charges": [{"minimum": 1116.45, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1116.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2242.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2242.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2360.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2124.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1581.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3242.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL 360 SYSTEM ANATOMIC BIPLANAR FIXATION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "sk12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9880.0, "discounted_cash": 5928.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTROL HEMORRHAGE ANTERIOR SIMPLE ANY METHOD 30901", "code_information": [{"code": "30901", "type": "CPT"}, {"code": "1857264", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL NASAL ANTERIOR COMPLEX ANY METHOD  30903", "code_information": [{"code": "30903", "type": "CPT"}, {"code": "9467894", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL NASAL HEMORRHAGE; POSTERIOR WITH NASAL PACKS AND/OR CAUTERY; ANY METHOD 30905", "code_information": [{"code": "30905", "type": "CPT"}, {"code": "33040437", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42970", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": 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data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL OROPHARYNGEAL HEMORRHAGE PRIMARY OR SEC. W/SEC. 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99.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 74.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 16.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 14.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COOMBS TEST INDIRECT TITER", "code_information": [{"code": "86886", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 78.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 156.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 156.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 165.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 148.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 110.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COPMONENT SHOULDER COMPR RV AUGUMENTED GUIDE AND BONE MODEL RIGHT 20-8090-004-02", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "20-8090-004-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1072.0, "discounted_cash": 643.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COPY NUMBER SEQUENCE ALYS", "code_information": [{"code": "156U", "type": "CPT"}], "standard_charges": [{"minimum": 4330.6, "maximum": 5095.16, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5095.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4330.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7516", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR ANGIO W/ILIC/FEM ANGIO", "code_information": [{"code": "C7517", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR ANGIO/VENT W/DRUG ADMIN", "code_information": [{"code": "C7558", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR ANGIO/VENT W/FFR", "code_information": [{"code": "C7557", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR ARTERY DISEASE MRNA", "code_information": [{"code": "81493", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 292.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 588.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 588.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 619.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 557.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 414.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3074.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2613.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ FLOW RESRV", "code_information": [{"code": "C7519", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7518", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ILIC/FEM ANG", "code_information": [{"code": "C7520", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORD ACTIVE USA SERIES USA ELITE SYS DISP", "code_information": [{"code": "DAC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.3, "discounted_cash": 47.58, "setting": "both", "billing_class": "facility"}]}, {"description": "CORD BI-POLAR CAUTERY STERILE 10-4000", "code_information": [{"code": "Oct-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.12, "discounted_cash": 25.87, "setting": "both", "billing_class": "facility"}]}, {"description": "CORD BIPLR 12FT BLUE CAUT FIT ALL STANDARD FORCEPS CABLE LF STRL", "code_information": [{"code": "DYNJ01207", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.73, "discounted_cash": 5.84, "setting": "both", "billing_class": "facility"}]}, {"description": "CORD BIPOLAR MOLDED CONNECTOR DISP", "code_information": [{"code": "E0512", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.31, "discounted_cash": 22.39, "setting": "both", "billing_class": "facility"}]}, {"description": "CORD BLOOD HARVESTING", "code_information": [{"code": "S2140", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORD BLOOD-DERIVED STEM-CELL", "code_information": [{"code": "S2142", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORD BLUE INTUITIVE BIPOLAR ENERGY 470384", "code_information": [{"code": "470384", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 718.2, "discounted_cash": 430.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CORD ELECTROSURGICAL 10FT MONOPOLAR FOOTSWITCH STRL PEDI DISP", "code_information": [{"code": "E0503", 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DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORETRAK  HEX DRIVER 3.5MM EFSR5002", "code_information": [{"code": "EFSR5002", "type": "CDM"}], "standard_charges": [{"gross_charge": 388.68, "discounted_cash": 233.21, "setting": "both", "billing_class": "facility"}]}, {"description": "CORF SKILLED NURSING SERVICE", "code_information": [{"code": "G0128", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORING REAMER, 8 MM, W/COLLARED PIN, STERILE", "code_information": [{"code": "AR-1222S", 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6502.08, "setting": "both", "billing_class": "facility"}]}, {"description": "CORNEA DSAEK 91", "code_information": [{"code": "C1818", "type": "HCPCS"}, {"code": "V0091", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 10836.8, "discounted_cash": 6502.08, "setting": "both", "billing_class": "facility"}]}, {"description": "CORNEA HALF MOON 8.5MM HALF THICKNESS HALO", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "HCO-HH1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 585.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CORNEA HALF MOON HALF THICKNESS", "code_information": [{"code": "V2785", "type": "HCPCS"}, {"code": "V0129/V0137", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 585.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CORNEAL HYSTERESIS DETER", "code_information": [{"code": "92145", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNEAL RELAXING INCISION 65772", "code_information": [{"code": "65772", "type": "CPT"}, {"code": "1480439", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNEAL SHIELD COLLAGEN 12HR", "code_information": [{"code": "A7012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.67, "discounted_cash": 78.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CORNEAL SMEAR", "code_information": [{"code": "65430", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY 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{"description": "CORNEAL TISSUE TRANSPLANT", "code_information": [{"code": "65767", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNEAL WEDGE RESECTION 65775", "code_information": [{"code": "65775", "type": "CPT"}, {"code": "1480440", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNERSTONE 8750044 SR RASP 10X14X14 8750044", "code_information": [{"code": "8750044", "type": "CDM"}], "standard_charges": [{"gross_charge": 603.29, "discounted_cash": 361.97, "setting": "both", "billing_class": "facility"}]}, {"description": "CORNERSTONE 8750144 SR RASP 11X14X14 8750144", "code_information": [{"code": "8750144", "type": "CDM"}], "standard_charges": [{"gross_charge": 603.29, "discounted_cash": 361.97, "setting": "both", "billing_class": "facility"}]}, {"description": "COROENT  LARGE MP   10X9X28 4DEG 6041028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6041028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "COROENT  LARGE MP   10X9X28 8DEG 6081028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6081028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11090.0, "discounted_cash": 6654.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COROENT  LARGE MP   12X9X28 4DEG 6041228", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6041228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "COROENT  LARGE MP   8X9X23 12DEG 6120823", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6120823", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "COROENT  LARGE MP   8X9X23 4DEG 6040823", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6040823", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COROENT  LARGE MP   8X9X23 8DEG 6080823", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6080823", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COROENT  LARGE MP   8X9X28 4DEG 6040828", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6040828", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COROENT  LARGE MP   9X9X23 4DEG 6040923", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6040923", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COROENT  LARGE MP   9X9X28 4DEG 6040928", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6040928", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COROENT SM ACR TA MARKER   11X15X12MM 10DEG 6734211", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6734211", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5187.0, "discounted_cash": 3112.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COROENT SM ACR TA MARKER   12X15X12MM 20DEG 6734412", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6734412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5187.0, "discounted_cash": 3112.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COROENT SM ACR TA MARKER   8X17X14MM 15DEG 6736308", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6736308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5187.0, "discounted_cash": 3112.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COROENT SM ACR TA MARKER   9X15X12MM 15DEG 6734309", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6734309", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5187.0, "discounted_cash": 3112.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COROENT XLCT 10MM X 18MM X 45MM 10DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6111045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CORONARY ART/GRFT ANGIO S&I", "code_information": [{"code": "93455", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 15456.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14607.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 11708.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11123.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10537.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 9952.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY ANGIO S&I", "code_information": [{"code": "93454", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 15456.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee 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SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14607.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 11708.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11123.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10537.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 9952.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY BYPASS/REOP", "code_information": [{"code": "33530", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY CORRECTION", "code_information": [{"code": "33502", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 66628.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 34236.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 56634.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 73234.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 81771.69, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 48899.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 46454.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", 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"standard_charge_dollar": 48899.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 46454.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 44009.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 41564.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [{"code": "325", "type": "MS-DRG"}], "standard_charges": [{"minimum": 32461.94, "maximum": 48899.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 32461.94, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", 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"methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT SKIN COLOR 6.0 CM/<", 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SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT SKIN COLOR EA 20.0CM", "code_information": [{"code": "11922", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT SKN COLOR 6.1-20.0CM", "code_information": [{"code": "11921", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee 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1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION CHORDEE OR REPAIR HYPOSPADIAS FIRST STAGE 54304", "code_information": [{"code": "54304", "type": "CPT"}, {"code": "1481907", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION CLAW FINGER 26499", "code_information": [{"code": "26499", "type": "CPT"}, {"code": "1480450", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee 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"plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION COCK UP 5TH TOE W/PLASTIC SKIN CLOSURE 28286", "code_information": [{"code": "28286", "type": "CPT"}, {"code": "2034644", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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P06N0511", "code_information": [{"code": "P06N0511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2149.2, "discounted_cash": 1289.52, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 4.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D5D51040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 641.14, "discounted_cash": 384.68, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 4.0MM CANNULATED DART FIRE", "code_information": [{"code": "DSDS1040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 388.68, "discounted_cash": 233.21, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 4.0MM-4.5MM HEADED CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSN20005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": 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"COUNTERSINK 6.5MM LARGE", "code_information": [{"code": "IW230532", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 565.25, "discounted_cash": 339.15, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 6MM SOLID 58870002", "code_information": [{"code": "58870002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 426.93, "discounted_cash": 256.16, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 7.0MM HEADED CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSN20007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 993.93, "discounted_cash": 596.36, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 7.2X200MM P20-915-7200", "code_information": [{"code": "P20-915-7200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.42, "discounted_cash": 378.25, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 8.0 FEET 2.0 CANN ZBCF-80-20", "code_information": [{"code": "ZBCF-80-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 704.9, "discounted_cash": 422.94, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK BLUNT NOSE 1.1MM CANNULATED VILEX", "code_information": [{"code": "2632-11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 462.84, "discounted_cash": 277.7, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK BLUNT NOSE 20MM CANNULATED", "code_information": [{"code": "Z630-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 635.74, "discounted_cash": 381.44, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK BONE 7.0MM MONSTER SCREWS", "code_information": [{"code": 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"code_information": [{"code": "45-30007S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 606.91, "discounted_cash": 364.15, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANN AO/QC 3.0/3.5 HEADED MSN20013", "code_information": [{"code": "MSN20013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 731.5, "discounted_cash": 438.9, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED 2.8MM AO COUPLING ASNIS STRL DISP", "code_information": [{"code": "45-20007S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 769.86, "discounted_cash": 461.92, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED 3.8MM AO COUPLING ASNIS STRL", "code_information": [{"code": "45-30007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 416.05, "discounted_cash": 249.63, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED 3MM TO 4MM DIA", "code_information": [{"code": "316-0001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 384.2, "discounted_cash": 230.52, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED 6MM", "code_information": [{"code": "DSDS1060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 611.8, "discounted_cash": 367.08, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED AO FITTING 4.0MM", "code_information": [{"code": "705260", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1276.8, "discounted_cash": 766.08, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED AO FITTING 5.0MM", "code_information": [{"code": "705261", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1276.8, "discounted_cash": 766.08, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED AO FITTING 7.0MM", "code_information": [{"code": "705262", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 893.76, "discounted_cash": 536.26, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED FOR 3 MM CANNULATED SCREW", "code_information": [{"code": "310.804", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1170.0, "discounted_cash": 702.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED FOR 3.5 MM AND 4 MM CANNULATED SCREW", "code_information": [{"code": "310.86", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 935.03, "discounted_cash": 561.02, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED LG SQC", "code_information": [{"code": "3-4000-14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 851.2, "discounted_cash": 510.72, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED MONSTER DISP 4.0MM", "code_information": [{"code": "P20-910-4000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 351.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED MONSTER DISP 4.5MM", "code_information": [{"code": "P20-910-4500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.42, "discounted_cash": 378.25, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED SM SMALL A/O COUNTERSINK CANNULATED SCREW SYS", "code_information": [{"code": "3-4000-13", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 851.2, "discounted_cash": 510.72, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED ZT642-14", "code_information": [{"code": "ZT642-14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 704.9, "discounted_cash": 422.94, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CORTEX 6MM", "code_information": [{"code": "702811", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1255.52, "discounted_cash": 753.31, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CORTEX SELF-TAP 2.0MM", "code_information": [{"code": "98201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 417.62, "discounted_cash": 250.57, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK FOR 2.5MM SCREWS 171-01025", "code_information": [{"code": "171-01025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 819.28, "discounted_cash": 491.57, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK FPS DISP 2.0MM", "code_information": [{"code": "323-1707", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 442.4, "discounted_cash": 265.44, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK FPS DISP 2.7MM", "code_information": [{"code": "323-1708", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 426.6, "discounted_cash": 255.96, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK MANUAL", "code_information": [{"code": "320-0024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 660.0, "discounted_cash": 396.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK MULTISCREW ACUMED 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"both", "billing_class": "facility"}]}, {"description": "COVER DRP 14IN X 24IN FOOTSWITCH", "code_information": [{"code": "FC-904", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.6, "discounted_cash": 9.96, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER EYE W/MEMBRANE", "code_information": [{"code": "65778", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", 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"standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COVER HANDLE LIGHT FLEXIBLE SOFT OPERATING ROOM LF STRL", "code_information": [{"code": "DYNJLHS2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.74, "discounted_cash": 1.04, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER HOLE SCREW R3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71369894", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 133.12, "discounted_cash": 79.87, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER HOLE SCREW REFLECTION", "code_information": [{"code": "71332500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 153.92, "discounted_cash": 92.35, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER HOLE THREADED R3 REFLECTION", 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"standard_charges": [{"gross_charge": 3.2, "discounted_cash": 1.92, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER LOCKING 8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "85-2108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER PLASTIC MAYO STAND 22/CS BXT8339", "code_information": [{"code": "BXT8339", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.98, "discounted_cash": 5.99, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER PROBE RIBBED ALARIS TRI-SITE TURBO-TEMP PLUS II DISP", "code_information": [{"code": "P850A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.13, "discounted_cash": 0.08, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER PROBE WITH LARGE 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[{"gross_charge": 0.43, "discounted_cash": 0.26, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER SHOE SMS DURA-FIT X-LG 4854", "code_information": [{"code": "4854", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.34, "discounted_cash": 0.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER STAND 24IN X 53IN BLUE MAYO LF STRL", "code_information": [{"code": "DYNJP2500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.45, "discounted_cash": 2.07, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER STAND MAYO 23PLACTIC FOB 30 CS", "code_information": [{"code": "8337", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.36, "discounted_cash": 3.22, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER STAND XL 30IN X 57IN MAYO PP LF STRL", "code_information": [{"code": "DYNJP2510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.35, "discounted_cash": 6.21, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER TABLE 44IN X 90IN SURG REINFORCED LF STRL DISP", "code_information": [{"code": "DYNJP2311", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.78, "discounted_cash": 4.07, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER TIP CAUTERY 8.0MM ENDOWRIST DA VINCI CRVD", "code_information": [{"code": "400180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.36, "discounted_cash": 52.42, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER TRANSDUCER 4CM X 30CM ROLLED FOR ULTRASOUND USE NEOGUARD LF", "code_information": [{"code": "610-844", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.3, "discounted_cash": 18.18, "setting": "both", "billing_class": "facility"}]}, {"description": "COVERALL ELAST CUFF ANKLE WHITE XXL 2202CV", "code_information": [{"code": "2202CV", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.71, "discounted_cash": 4.63, "setting": "both", "billing_class": "facility"}]}, {"description": "COVERLOC ASSEMBLY CALCANEUS AFPCPC", "code_information": [{"code": "AFPCPC", "type": "CDM"}], "standard_charges": [{"gross_charge": 398.16, "discounted_cash": 238.9, "setting": "both", "billing_class": "facility"}]}, {"description": "COVERLOC ASSEMBLY LATERAL TALUS AFPCPLT", "code_information": [{"code": "AFPCPLT", "type": "CDM"}], "standard_charges": [{"gross_charge": 398.16, "discounted_cash": 238.9, "setting": "both", "billing_class": "facility"}]}, {"description": "COVID-19 Ab, IgG", "code_information": [{"code": "86769", "type": "CPT"}, {"code": "45619229", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 78.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 82.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 74.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 55.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee 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"AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRADLE ARM POSITION ADJ FOAM", "code_information": [{"code": "5823-10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.84, "discounted_cash": 16.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CRAINIAL STAPLE SZ L SX878T", "code_information": [{"code": "SX878T", "type": "CDM"}], "standard_charges": [{"gross_charge": 1701.0, "discounted_cash": 1020.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [{"code": "73", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10357.47, "maximum": 17530.2, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 17530.2, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10357.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [{"code": "74", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7148.43, "maximum": 11822.9, "estimated_discounted_cash": 8946.17, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11822.9, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7148.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIAL BUR 4.0MM ROUND DIAMOND 5820-012-040D", "code_information": [{"code": "5820-012-040D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 334.23, "discounted_cash": 200.54, "setting": "both", "billing_class": "facility"}]}, {"description": "CRANIAL STAPLE SZ M SX877T", "code_information": [{"code": "SX877T", "type": "CDM"}], "standard_charges": [{"gross_charge": 1701.0, "discounted_cash": 1020.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CRANIECTOMY;WITH EXCISION OF TUMOR 61500", "code_information": [{"code": "61500", "type": "CPT"}, {"code": "1480464", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8945.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3330.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4892.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6688.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6336.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4717.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIEL STAPLE SZ S SX876T", "code_information": [{"code": "SX876T", "type": "CDM"}], "standard_charges": [{"gross_charge": 1701.0, "discounted_cash": 1020.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61580", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61581", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61582", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61583", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [{"code": "26", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16433.0, "maximum": 35154.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 34690.64, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 20090.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 31983.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 16433.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 27186.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 35154.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 22135.24, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 23471.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 22297.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 21124.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 19950.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [{"code": "25", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16433.0, "maximum": 50724.83, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 50724.83, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 20090.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 31983.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 16433.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 27186.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 35154.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 31396.85, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 23471.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 22297.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 21124.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 19950.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "27", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16433.0, "maximum": 35154.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 3870.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 6403.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 9144.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 44751.25, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE 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"CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 27186.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 35154.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 40077.13, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 23471.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 22297.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 21124.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 19950.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC", "code_information": [{"code": "24", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16433.0, "maximum": 43118.88, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 43118.88, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 20090.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 31983.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 16433.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 27186.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 35154.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 28768.4, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 23471.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 22297.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 21124.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 19950.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRCLG STRAIGHT PASSER SM DISPOSABLE AR-7825", "code_information": [{"code": "AR-7825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 648.77, "discounted_cash": 389.26, 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATINE ISOFORMS", "code_information": [{"code": "82554", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 50.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 101.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 101.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 106.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 95.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 71.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 34.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 27.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 23.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATION OF LESION BY STEROTACTICPERCUTANEOUS NEURO.AGENT TRIGEMINAL MEDULLAR 61791", "code_information": [{"code": "61791", "type": "CPT"}, {"code": "1480493", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATION OF SHUNT LUMBAR NOT REQUIRING LAMINECTOMY 63741", "code_information": [{"code": "63741", "type": "CPT"}, {"code": "1480494", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATION OF SHUNT LUMBAR;INCLUDING LAMINECTOMY 63740", "code_information": [{"code": "63740", "type": "CPT"}, {"code": "1480495", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee 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"standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREO MIS MODULAR POLYAXIAL TULIP  10MM 1134.011", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1134.011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5636.8, "discounted_cash": 3382.08, "setting": "both", "billing_class": "facility"}]}, {"description": "CRH STIMULATION PANEL", "code_information": [{"code": "80412", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2699.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5421.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 5421.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 5706.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5135.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 3823.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2347.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1995.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRICOTRACHEAL RESECTION", "code_information": [{"code": "31592", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO 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"UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRNOP SKULL DEFECT<5 CM DIAM", "code_information": [{"code": "62140", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee 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"code_information": [{"code": "62141", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRNOP W/AUTOGRAFT<5 CM DIAM", "code_information": [{"code": "62146", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", 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"standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 489.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 489.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 515.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 463.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 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"standard_charge_dollar": 139.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 29.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CS ALL-POLYETHYLENE TIBIA COMP 5534-A-109", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5534-A-109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5750.03, "discounted_cash": 3450.02, "setting": "both", "billing_class": "facility"}]}, {"description": "CSF Glu", "code_information": [{"code": "82945", "type": "CPT"}, {"code": "1099836", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "gross_charge": 173.0, "discounted_cash": 103.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 83.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 83.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 88.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 79.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 59.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 11.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF LEAKAGE IMAGING", "code_information": [{"code": "78650", "type": "CPT"}], "standard_charges": [{"minimum": 384.52, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 384.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 772.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 772.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 812.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 731.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 544.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5810.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4938.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF SHUNT EVALUATION", "code_information": [{"code": "78645", "type": "CPT"}], "standard_charges": [{"minimum": 513.44, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 513.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1031.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1031.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1085.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 976.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 727.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF SHUNT REPROGRAM", "code_information": [{"code": "62252", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF TP", "code_information": [{"code": "84157", "type": "CPT"}, {"code": "1099835", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "gross_charge": 52.0, "discounted_cash": 31.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 44.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 89.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 89.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 94.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 85.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 63.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 11.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 9.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF VENTRICULOGRAPHY", "code_information": [{"code": "78635", "type": "CPT"}], "standard_charges": [{"minimum": 699.08, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 699.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1404.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1404.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1477.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1330.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 990.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSTB FULL GENE ANALYSIS", "code_information": [{"code": "232U", "type": "CPT"}], "standard_charges": [{"minimum": 684.01, "maximum": 804.77, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 804.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 684.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSTB GENE DETC ABNOR ALLELE", "code_information": [{"code": "81188", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 401.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 340.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSTB GENE FULL GENE SEQUENCE", "code_information": [{"code": "81189", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1752.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Abd and Pelvis w/ + w/o Con 74178", "code_information": [{"code": "74178", "type": "CPT"}, {"code": "1171864", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 2969.93, "maximum": 8427.0, "gross_charge": 6319.0, "discounted_cash": 3791.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 3475.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 2969.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 3159.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 3285.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3194.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6415.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6415.11, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 3125.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3038.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6101.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6101.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6423.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", 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CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2690.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2690.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2831.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2548.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1897.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT BONE DENSITY AXIAL", "code_information": [{"code": "77078", "type": "CPT"}], "standard_charges": [{"minimum": 175.8, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 175.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 353.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 353.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 371.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 334.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 249.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D BI C-/C+", "code_information": [{"code": "638T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D UNI C-", "code_information": [{"code": "633T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CT COLONOGRAPHY DX", "code_information": [{"code": "74261", "type": "CPT"}], "standard_charges": [{"minimum": 567.72, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 567.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1140.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1140.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1200.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1080.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 804.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT COLONOGRAPHY DX W/DYE", "code_information": [{"code": "74262", "type": "CPT"}], "standard_charges": [{"minimum": 567.72, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 567.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1140.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1140.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1200.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1080.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 804.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT COLONOGRAPHY SCREENING", "code_information": [{"code": "74263", "type": "CPT"}], "standard_charges": [{"minimum": 766.46, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 766.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1539.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1539.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1620.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1458.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1085.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Chest High Resolution 71250", "code_information": [{"code": "71250", "type": "CPT"}, {"code": "36648783", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 1196.15, "maximum": 8427.0, "gross_charge": 2545.0, "discounted_cash": 1527.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 1399.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 1196.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 1272.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 1323.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1286.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2583.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2583.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2719.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2447.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1821.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Elbow w/ + w/o Contrast Left 73202", "code_information": [{"code": "73202", "type": "CPT"}, {"code": "629822", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 1600.82, "maximum": 8427.0, "gross_charge": 3406.0, "discounted_cash": 2043.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 1873.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 1600.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 1703.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 1771.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1721.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3457.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3457.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3639.57, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3639.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3275.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2438.52, "methodology": "fee schedule"}], 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"standard_charge_dollar": 2840.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2840.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2989.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2690.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2003.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Head or Brain w/ + w/o Contrast 70470", "code_information": [{"code": "70470", "type": "CPT"}, {"code": "629958", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 1515.28, "maximum": 8427.0, "gross_charge": 3224.0, "discounted_cash": 1934.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 1773.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 1515.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 1612.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2983.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2684.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1998.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT PE Protocol 71275", "code_information": [{"code": "71275", "type": "CPT"}, {"code": "36648773", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 1515.28, "maximum": 8427.0, "gross_charge": 3224.0, "discounted_cash": 1934.4, "setting": "both", 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"standard_charge_dollar": 3081.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3243.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2919.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2173.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT PERFUSION W/CONTRAST CBF", "code_information": [{"code": "42T", "type": "CPT"}], "standard_charges": [{"minimum": 842.6, "maximum": 4173.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 842.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1692.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1692.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1781.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1603.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1193.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT Pelvis w/ + w/o Contrast 72194", "code_information": [{"code": "72194", "type": "CPT"}, {"code": "630108", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 1515.28, "maximum": 8427.0, "gross_charge": 3224.0, "discounted_cash": 1934.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 1773.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 1515.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 1612.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 1676.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1601.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3216.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3216.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3385.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO 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"standard_charge_dollar": 2959.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3114.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2803.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2087.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Pelvis w/o Contrast 72192", "code_information": [{"code": "72192", "type": "CPT"}, {"code": "630114", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 1182.99, "maximum": 8427.0, "gross_charge": 2517.0, "discounted_cash": 1510.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 1384.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 1182.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 1258.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 1308.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1208.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2428.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2428.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2555.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2300.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1712.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Renal Stone Protocol 74176", "code_information": [{"code": "74176", "type": "CPT"}, {"code": "36648767", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 2277.15, "maximum": 8427.0, "gross_charge": 4845.0, "discounted_cash": 2907.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 2664.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 2277.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 2422.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 2519.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2449.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4919.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 4919.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 5177.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 4660.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 3469.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT SCAN FOR NEEDLE BIOPSY", "code_information": [{"code": "77012", "type": "CPT"}], "standard_charges": [{"minimum": 608.95, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and 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"standard_charge_dollar": 1287.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1158.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 862.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT SCAN FOR THERAPY GUIDE", "code_information": [{"code": "77014", "type": "CPT"}], "standard_charges": [{"minimum": 386.39, "maximum": 8427.0, "setting": "outpatient", "payers_information": 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"standard_charge_dollar": 1669.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 1426.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 1517.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 1578.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1534.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3081.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3081.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3243.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2919.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2173.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Thorax w/o Contrast 71250", "code_information": [{"code": "71250", "type": "CPT"}, {"code": "629704", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 1196.15, "maximum": 8427.0, "gross_charge": 2545.0, "discounted_cash": 1527.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 1399.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 1196.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 1272.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 1323.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1286.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2583.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2583.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2719.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2447.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1821.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Tibia/Fibula w/o Contrast Bl  73700", "code_information": [{"code": "73700", "type": "CPT"}, {"code": "630201", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 1339.49, "maximum": 8427.0, "gross_charge": 5299.0, "discounted_cash": 3179.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 2914.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 2490.53, "methodology": "fee schedule"}, 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"standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRAFT F/N/HF/G", "code_information": [{"code": "15155", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRAFT T/A/L +%", "code_information": [{"code": "15152", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT F/N/HFG ADD", "code_information": [{"code": "15156", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT T/A/L ADDL", "code_information": [{"code": "15151", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT T/ARM/LEG", "code_information": [{"code": "15150", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTR OOCYTE/EMBRYO <4 DAYS", "code_information": [{"code": "89250", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 334.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 671.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 671.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 706.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 635.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 473.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 94.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 79.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTECTOMY W/BILATERAL PELVIC LYMPHADENECTOMY 51575", "code_information": [{"code": "51575", "type": "CPT"}, {"code": "1480526", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"8065425120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.05, "discounted_cash": 13.23, "setting": "both", "billing_class": "facility"}]}, {"description": "CYSTITOME IRRIGATING 25GA FORMED REVERSE CUTTING SHRT RADIUS OPHTHALMIC STRLINST", "code_information": [{"code": "8065424620", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.11, "discounted_cash": 13.27, "setting": "both", "billing_class": "facility"}]}, {"description": "CYSTITOME IRRIGATING 25GA STRAIGHT REVERSE CUTTING OPHTHALMIC STRLINSTR DISP", "code_information": [{"code": "8065425320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.24, "discounted_cash": 13.34, "setting": "both", "billing_class": "facility"}]}, {"description": "CYSTO LASER TX URETERAL CALC", "code_information": [{"code": "S2070", "type": "HCPCS"}], "standard_charges": [{"minimum": 6850.0, "maximum": 14483.0, "setting": "outpatient", 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"plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO W/TEMP PROS IMPLANT", "code_information": [{"code": "C9769", "type": "HCPCS"}], "standard_charges": [{"minimum": 4173.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO/LITHO/VACUUM ASPIRATION OF KIDNEY C9761", "code_information": [{"code": "C9761", "type": "HCPCS"}, {"code": "46355443", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3866.0, "maximum": 10329.0, "gross_charge": 13450.0, "discounted_cash": 8070.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 7397.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOLITHOTOMY/CYSTOTOMY W/REMOVAL OF CALCULUS 51050", "code_information": [{"code": "51050", "type": "CPT"}, {"code": "1480531", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 574.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 605.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 544.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 405.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/VP", "code_information": [{"code": "51728", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 405.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/VP&UP", "code_information": [{"code": "51729", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1245.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2501.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2501.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2633.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2369.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1764.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTORRHAPHY-SUTURE OF 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTORRHAPHY-SUTURE OF BLADDER WOUND/INJURY/RUPTURE-SIMPLE 51860", "code_information": [{"code": "51860", "type": "CPT"}, {"code": "1481833", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": 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"plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 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FLOW 601", "code_information": [{"code": "601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.49, "discounted_cash": 15.89, "setting": "both", "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & DUCT CATHETER", "code_information": [{"code": "52010", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52277", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52301", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY BLADDER WASHINGS 51700", "code_information": [{"code": "51700", "type": "CPT"}, {"code": "1480532", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY CYSTOMETROGRAM-COMPLEX 51726", "code_information": [{"code": "51726", "type": "CPT"}, {"code": "1480533", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 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"standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY INJECT MATERIAL", "code_information": [{"code": "52327", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY STONE REMOVAL", "code_information": [{"code": 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6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSTOMY CYSTOTOMY W/DRAINAGE 51040", "code_information": [{"code": "51040", "type": "CPT"}, {"code": "1480539", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOTOMY W/CALCULUS BASKET EXTRACTION 51065", "code_information": [{"code": "51065", "type": "CPT"}, {"code": "45523474", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOTOMY W/INSERTION OF URETERAL CATHETER OR STENT  51045", "code_information": [{"code": "51045", "type": "CPT"}, {"code": "15361128", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY BLADDER DISTENSION W/GENERAL ANESTHESIA 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"plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 87.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 176.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 176.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 185.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 167.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 124.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 30.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 26.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Comprehensive, Clinical Pathology Consultation", "code_information": [{"code": "80502", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Computerized Axial Tomography (Cat) Scan, Other", "code_information": [{"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 1113.0, "maximum": 2308.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1361.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1980.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1113.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1683.0, "methodology": "other"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1524.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1617.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1536.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1455.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1374.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1446.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2308.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2077.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Computerized Axial Tomography (Cat)Scan, Body Scan", "code_information": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2077.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Computerized Axial Tomography (Cat)Scan, Head Scan", "code_information": [{"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 1113.0, "maximum": 2308.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1361.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1980.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1113.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1683.0, "methodology": "other"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1524.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1617.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1536.0, "methodology": "other"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", 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"BCBS PPO DFW", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 222.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 165.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 83.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 70.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Continuous Ambulatory Peritoneal Dialysis (Capd)- 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{"description": "Continuous Ambulatory Peritoneal Dialysis (Capd)- Outpatient Or Home Home Equipment", "code_information": [{"code": "843", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Continuous Ambulatory Peritoneal Dialysis (Capd)- Outpatient Or Home Home Supplies", "code_information": [{"code": "842", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Continuous Ambulatory Peritoneal Dialysis (Capd)- Outpatient Or Home Maintenance/100%", "code_information": [{"code": "844", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Continuous Ambulatory Peritoneal Dialysis (Capd)- Outpatient Or Home Other", "code_information": [{"code": "849", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Continuous Ambulatory Peritoneal Dialysis (Capd)- Outpatient Or Home Support Services", "code_information": [{"code": "845", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for 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"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": "Continuous Cycling Peritoneal Dialysis (Ccpd) - Outpatient Or Home General", "code_information": [{"code": "850", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Continuous Cycling Peritoneal Dialysis (Ccpd) - Outpatient Or Home Home Equipment", "code_information": [{"code": "853", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Continuous Cycling Peritoneal Dialysis (Ccpd) - Outpatient Or Home Home Supplies", "code_information": [{"code": "852", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Continuous Cycling Peritoneal Dialysis (Ccpd) - Outpatient Or Home Maintenance/100%", "code_information": [{"code": "854", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Continuous Cycling Peritoneal Dialysis (Ccpd) - Outpatient Or Home Other", "code_information": [{"code": "859", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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"plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS DISC RF LUMBAR", "code_information": [{"code": "S2348", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FINGERS/HAND", "code_information": [{"code": "26035", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINE CORD ADD-ON", "code_information": [{"code": "63066", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION FASCIOTOMY MULTIPLE COMPARTMENTS THIGH OR KNEE 27498", "code_information": [{"code": "27498", "type": "CPT"}, {"code": "1480592", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION FASCIOTOMY WRIST W/DEBRIDEMENT 25023", "code_information": [{"code": "25023", "type": "CPT"}, {"code": "1480596", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION FASCIOTOMY WRIST W/O DEBRIDEMENT 25020", "code_information": [{"code": "25020", "type": "CPT"}, {"code": "1480598", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION TARSAL TUNNEL RELEASE 28035", "code_information": [{"code": "28035", "type": "CPT"}, {"code": "1480595", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", 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"plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 76.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 154.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 154.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 162.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 146.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 108.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 85.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 72.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEOXYRIBONUCLEASE ANTIBODY", "code_information": [{"code": "86215", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 63.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 126.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 126.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 133.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 120.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 89.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 38.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 32.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEPO-MEDROL/METHYLPREDNISOLONE ACETATE 40MG/ML", "code_information": [{"code": "MED0068", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 36.16, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DEPO-MEDROL/METHYLPREDNISOLONE ACETATE 80MG/ML 1ML VIAL", "code_information": [{"code": "MED0069", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 66.39, "discounted_cash": 39.83, "setting": "both", "billing_class": "facility"}]}, {"description": "DEPO-MEDROL/METHYLPREDNISOLONE ACETATE 80MG/ML PF 1ML VIAL", "code_information": [{"code": "MED0594", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 54.9, "discounted_cash": 32.94, "setting": "both", "billing_class": "facility"}]}, {"description": "DEPRESSIVE NEUROSES", "code_information": [{"code": "881", "type": "MS-DRG"}], "standard_charges": [{"minimum": 274.0, "maximum": 5567.39, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1736.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1875.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2672.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 304.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 274.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1885.0, "methodology": "per diem"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5567.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEPRESSOR TONGUE 5 1/2IN WOOD LF STRL", "code_information": [{"code": "MDS202073", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.12, "discounted_cash": 0.07, "setting": "both", "billing_class": "facility"}]}, {"description": "DEPRESSOR TONGUE 6IN WOOD LF STRL", "code_information": [{"code": "MDS202075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.12, "discounted_cash": 0.07, "setting": "both", "billing_class": "facility"}]}, {"description": "DEPTH GAUGE DRILL THREADED", "code_information": [{"code": "95151", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 124.8, "discounted_cash": 74.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DEPUY SYNTHES HAMMERTOE CCI STD KIT W/1.25 K-WIRE/ STERILE 46.239.001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "46.239.001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6037.2, "discounted_cash": 3622.32, "setting": "both", "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT F/N/HF/G ADD", "code_information": [{"code": "15136", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT FACE/NCK/HF/G", "code_information": [{"code": "15135", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT T/A/L ADD-ON", "code_information": [{"code": "15131", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT TRNK/ARM/LEG", "code_information": [{"code": "15130", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMABRASION FACE 15780", "code_information": [{"code": "15780", "type": "CPT"}, {"code": "1480606", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMATOLIPECTOMY THIGH 15832", "code_information": [{"code": "15832", "type": "CPT"}, {"code": "1480612", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMIS DECELLULARIZED 40MM X 70MM X 3.0MM AFLEX301", "code_information": [{"code": "Q4125", "type": "HCPCS"}, {"code": "AFLEX301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10111.4, "discounted_cash": 6066.84, "setting": "both", "billing_class": "facility"}]}, {"description": "DESARA BLUE SLING SYSTEM", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "CAL-DS01BA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2433.2, "discounted_cash": 1459.92, "setting": "both", "billing_class": "facility"}]}, {"description": "DESIGN CUSTOM BREAST IMPLANT", "code_information": [{"code": "19396", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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"standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 521.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1046.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1046.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1101.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 991.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 738.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1570.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1334.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESOXYCORTICOSTERONE", "code_information": [{"code": "82633", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 169.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 341.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 341.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 358.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 323.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 240.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 90.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 77.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTROY INTERNAL HEMORRHOIDS", "code_information": [{"code": "46930", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee 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"plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTROY PREMAL LESIONS 15/>", "code_information": [{"code": "17004", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCT NEURO.AGENT TRIGEM NERVE 2ND & 3RD DIV.BRANCH AT FORAMEN OVALE W/IMAG 64610", "code_information": [{"code": "64610", "type": "CPT"}, {"code": "1480614", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCT NEUROLYTIC AGENT TRIGEM.NERVE 2ND & 3RD DIV.BRANCH AT FORAMEN OVALE 64605", "code_information": [{"code": "64605", "type": "CPT"}, {"code": "1480615", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCT NEUROLYTIC AGENT TRIGEM.NERVE;SUPRA/INFRAORBITAL & MENTAL/INFERIOR 64600", "code_information": [{"code": "64600", "type": "CPT"}, {"code": "1480616", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCT PREMALG LESION", "code_information": [{"code": "17000", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION BY NEURO AGENT PARAVERT FACET W/IMAGE CERV.OR THOR. 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SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION BY NEUROLYTIC AGENT GENICULAR NERVE BRANCH W/IMAGING 64624", "code_information": [{"code": "64624", "type": "CPT"}, {"code": "45577565", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2436.5, "maximum": 8427.0, "gross_charge": 4430.0, "discounted_cash": 2658.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 2436.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION BY NEUROLYTIC AGENT INTERCOSTAL NERVE 64620", "code_information": [{"code": "64620", "type": "CPT"}, {"code": "1480617", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee 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"standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION BY NEUROLYTIC AGENT OTHER PERIPHERAL NERVE OR BRANCH 64640", "code_information": [{"code": "64640", "type": "CPT"}, {"code": "1480618", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 10356.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": 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[{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION BY NEUROLYTIC AGENT/PUDENDAL NERVE 64630", "code_information": [{"code": "64630", "type": "CPT"}, {"code": "1480620", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION CILIARY BODY", "code_information": [{"code": "66700", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 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0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 328.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 659.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 659.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 694.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 624.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 465.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 127.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DETECTOR CARBON DIOXIDE 18 X 15MM PEDI NELLCOR VISUAL INDICATOR", "code_information": [{"code": "PEDICAP 6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.04, "discounted_cash": 28.82, "setting": "both", "billing_class": "facility"}]}, {"description": "DETECTOR CO2 18MM 15MM 5MM CONNECTION PORT CO2 FOR ENDO TUBE PLACEMENT EASY CAP", "code_information": [{"code": "PEDICAP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.08, "discounted_cash": 35.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DETECTOR CO2 DBD EASY CAP II", "code_information": [{"code": "EASYCAP II 6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.04, "discounted_cash": 28.82, "setting": "both", "billing_class": "facility"}]}, {"description": "DETECTOR CO2 EASYCAP2-6 ADLT", "code_information": [{"code": "EASYCAP2-6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.15, "discounted_cash": 30.69, "setting": "both", "billing_class": "facility"}]}, {"description": "DETECTOR EASY CAP II CO2 EASYCAP II", "code_information": [{"code": "EASYCAP II", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.8, "discounted_cash": 28.68, "setting": "both", "billing_class": "facility"}]}, {"description": "DETERMINE REFRACTIVE STATE", "code_information": [{"code": "92015", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEV INTERROG REMOTE 1/2/MLT", "code_information": [{"code": "93295", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVEL TST PHYS/QHP 1ST HR", "code_information": [{"code": "96112", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVEL TST PHYS/QHP EA ADDL", "code_information": [{"code": "96113", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO 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"both", "billing_class": "facility"}]}, {"description": "DEVICE 4-0 VLOC90 BARBED SUTURE P-12 VLOCM0023", "code_information": [{"code": "VLOCM0023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 116.12, "discounted_cash": 69.67, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE AIRWAY SZ 3 LMA SUPREME", "code_information": [{"code": "175030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.45, "discounted_cash": 32.67, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE AIRWAY SZ 4 LMA SUPREME", "code_information": [{"code": "175040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.45, "discounted_cash": 32.67, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE AIRWAY SZ 5 LMA SUPREME", "code_information": [{"code": "175050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.45, "discounted_cash": 32.67, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE ANNEX HALF JOG 5.5 X 40 MM NHPL PERI OP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "Nov-41", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11891.5, "discounted_cash": 7134.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE BALLOON AUGMENTATION 10MM 11GA VERTEBRAL IVAS", "code_information": [{"code": "705-310-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2197.8, "discounted_cash": 1318.68, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE BIOPSY BONE CONICAL TIP DESIGN KYPHX EXPRESS", "code_information": [{"code": "F07A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 290.88, "discounted_cash": 174.53, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE BIOPSY SZ 3 BONR TREPHINE KYPHON EXPRESS", "code_information": [{"code": "F05A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 359.2, "discounted_cash": 215.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE CANNULA 7FR 7FT TUBING CURVED NASAL NON FLARED TIP AIRLIFE", "code_information": [{"code": "1312", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.51, "discounted_cash": 0.91, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE CANNULA BLENDING CONNECTOR GPS II CLOTALYST", "code_information": [{"code": "800-0204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 124.8, "discounted_cash": 74.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE CAPTURING 25 CM SUT STANDARD OR OPEN ACCESS PUSH CATCH", "code_information": [{"code": "M0068311251", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 914.54, "discounted_cash": 548.72, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE CATH 18FR 5CC BLLN THREE WAY STANDARD TIP SILICONE ELASTOMER FOLEY DOVER", "code_information": [{"code": "8887688185", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.41, "discounted_cash": 26.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE CATH 19GA CHOLANGIOGRAPHY", "code_information": [{"code": "CC-19", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 141.95, "discounted_cash": 85.17, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE CLARIFIX CRYOTHERAPY CFX-2000", "code_information": [{"code": "CFX-2000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3431.83, "discounted_cash": 2059.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE CLOSE ENDOSCOPIC TROCAR SITE 173022", "code_information": [{"code": "173022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 116.48, "discounted_cash": 69.89, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE CLUTCH GRASPER MINIGRIP DISPOSABLE", "code_information": [{"code": "PGCC300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 438.9, "discounted_cash": 263.34, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE COHERE XLW 12X22X45MM 10 8221245P2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8221245P2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12090.0, "discounted_cash": 7254.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE COLLECTION VITAGEL CELLPAKER", "code_information": [{"code": "2113-0010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 153.0, "discounted_cash": 91.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE DISSECTION PEAK PLASMABLADE 4.0 PS200-040", "code_information": [{"code": "PS200-040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 732.83, "discounted_cash": 439.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE DRAINAGE GLAUCOMA AHMED IMP", "code_information": [{"code": "C1783", "type": "HCPCS"}, {"code": "S2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1722.69, "discounted_cash": 1033.61, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE EGIA 45 AR MED THKSUL EGIA45AMT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EGIA45AMT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 324.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE ELECTROSURGICL TISSUE 10CORD FT3000", "code_information": [{"code": "FT3000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.08, "discounted_cash": 77.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE ENDO GIA ARTIC 45 VASC MED RELOAD EGIA45AVM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EGIA45AVM", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 520.0, "discounted_cash": 312.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE ENDO GIA ARTIC 60 MED THK REL EGIA60AMT", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "EGIA60AMT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1171.3, "discounted_cash": 702.78, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE ENDO GIA ARTIC 60 VASC MED RE EGIA60AVM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EGIA60AVM", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1357.15, "discounted_cash": 814.29, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE EPISTAXIS 5.5 CM ANT DRESSING RAPID RHINO", "code_information": [{"code": "RR550", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 188.57, "discounted_cash": 113.14, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE EXTRACTION CONICAL FOR THREADED WASHER", "code_information": [{"code": "309.501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 470.02, "discounted_cash": 282.01, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FILTRATION 2.64MM GLAUCOMA P 50 MODELINTERNAL LUMEN EX PRESS", "code_information": [{"code": "C1783", "type": "HCPCS"}, {"code": "47053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3115.82, "discounted_cash": 1869.49, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXATION GRAFTMAX BUTTON ALB ADJUSTABLE LOOP BUTTON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "KS-ALB", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 825.0, "discounted_cash": 495.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXATION TIGHTROPE BTB DEPLOYING SUTURE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588BTB-J", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1335.0, "discounted_cash": 801.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXATION ZIPLOOP SZ1 TOGGLELOC AC JOINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "904834", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1603.95, "discounted_cash": 962.37, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXTN 45MM FEMORAL FXTN ACL PCL RECONSTRUCTION ARTHRO W/ ULTRABRAID #5 LE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72200152", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 708.24, "discounted_cash": 424.94, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXTN 5MM 20 SHOT FASTENER SQUEEZE HANDLE ABSORB FOR FXTN SYS ABSORBATACK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ABSTACK20", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1794.59, "discounted_cash": 1076.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXTN 5MM 30 TACK ABSORBL FXTN RATCHETED HANDLE FOR LAPATOSCOPIC HERNIA R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ABSTACK30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1191.4, "discounted_cash": 714.84, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXTN AC JOINT REPAIR DOUBLE ZIPLOOP W/ ZIPLOOP TECHNOLOGY ZIPTIGHT TOGGL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "904835", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2080.8, "discounted_cash": 1248.48, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXTN ANKLE SYNDESMOSIS ZIPLOOP TECHNOLOGY ZIPTIGHT TI STRLINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "909853", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2584.4, "discounted_cash": 1550.64, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FIXTN FEMRL W/ ZIPLOOP TECHNOLOGY FOR BONE TO BONE GRAFTS TOGGLELOCINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "909849", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3762.2, "discounted_cash": 2257.32, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FORCE BIPOLAR WITH DUAL GRIP REUSABLE 471405", "code_information": [{"code": "471405", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6395.76, "discounted_cash": 3837.46, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FUSION 10MM X 22MM X 50MM XLINTERBODY WIDE COROENT XL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6910250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14067.73, "discounted_cash": 8440.64, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FUSION 11MM X 14MM X 5MMINTERBODY CERVICAL TM S", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "6-101-02051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8528.0, "discounted_cash": 5116.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FUSION 11MM X 14MM X 6MM INTERBODY CERVICAL TM S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6-101-02061", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8528.0, "discounted_cash": 5116.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FUSION 11MM X 14MM X 7MMINTERBODY CERVICAL TM S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6-101-02071", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2520.0, "discounted_cash": 1512.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FUSION 12MM X 18MM X 45MM XLINTERBODY 10 DEGREE COROENT XL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6981245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10400.0, "discounted_cash": 6240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FUSION 12MM X 18MM X 45MM XLINTERBODY COROENT IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6912845", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10400.0, "discounted_cash": 6240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FUSION 12MM X 20MM 5DEG ANGLE BODYINTERVERTINTERFUSE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9076-12-20-5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17000.0, "discounted_cash": 10200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FUSION 6MM X 16MM X 24MM XLINTERBODY THORACIC COROENT XL IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6990635", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16158.0, "discounted_cash": 9694.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FUSION 8MM X 10MM X 35MMINTERBODY OBLIQUE TLIF COROENT IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6850812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11734.0, "discounted_cash": 7040.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FUSION MODULUS XLW 12 X 22 X 55MM 10DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1221255P2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FUSION OPEN VOYANT CRV BLUNT JAW DUAL 20CM EB240", "code_information": [{"code": "EB240", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1037.4, "discounted_cash": 622.44, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FUSION VOYANT 5MM STRT BLUNT JAW 37CM EB210", "code_information": [{"code": "EB210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1037.4, "discounted_cash": 622.44, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN 10 TACK 5MM ABSORBATACK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ABSTACK10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1345.2, "discounted_cash": 807.12, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN 5MM SQUEEZE HANDLE 15 SHOT ABSORBATACK DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ABSTACK15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1240.35, "discounted_cash": 744.21, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN 5MM TACKER AUTO SUT SNGL USE", "code_information": [{"code": "OMS-TTSD30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1104.76, "discounted_cash": 662.86, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN 7MM X 45MM CORTICAL VIPER IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1867-31-745", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3432.0, "discounted_cash": 2059.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN FEMORAL W/ ZIPLOOP TECHNOLOGY IMPLANT SYS TOGGLELOC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "909848", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4105.1, "discounted_cash": 2463.06, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN KNOTLESS SPEEDLOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OM-7500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1755.0, "discounted_cash": 1053.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN MENISCAL REPAIR SYS CURVED LOW PROFILE FAST-FIX 360", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72202468", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1410.24, "discounted_cash": 846.14, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN MENISCAL REPAIR SYS REVERSE CURVED FAST-FIX 360", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72202469", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7280.0, "discounted_cash": 4368.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN MENISCAL REPAIR SYS STRAIGHT LOW PROFILE FAST-FIX 360", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72202467", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1354.18, "discounted_cash": 812.51, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE FXTN TIGHTROPE BTB BONE TENDON BONE ACL BTB TIGHTROPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588BTB", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1824.0, "discounted_cash": 1094.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE HANDLING PHYS/QHP", "code_information": [{"code": "99002", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", 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{"description": "DEVICE REAMER 11MM PIN KNEE FLIPCUTTER IIINSTR", "code_information": [{"code": "AR-1204AF-110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 864.5, "discounted_cash": 518.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE REATTACHMENT SM TROCHANTER FOR CABLE SYS TITANIUM ALLOY STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "498.806S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5793.42, "discounted_cash": 3476.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE REMOVAL TISSUE HYSTEROSCOPIC MYOSURE", "code_information": [{"code": "10-403", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2019.6, "discounted_cash": 1211.76, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE REMOVAL TISSUE HYSTEROSCOPIC MYOSURE DISP", "code_information": [{"code": 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{"description": "DEVICE SKIN CLOSURE ADHESIVE UP 16CM ZIP", "code_information": [{"code": "PS1160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 284.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE STABLZN ARTERIAL ULTRA ANCHOR PD PICC TRICOT STATLOCK", "code_information": [{"code": "PIC0220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.04, "discounted_cash": 13.82, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE STABLZN FOLEY SWIVEL TRICOT STATLOCK LF", "code_information": [{"code": "FOL0102", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.78, "discounted_cash": 8.87, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE STIMULATOR NERVE HND HELD VARI STIM III DISP", "code_information": [{"code": "8562010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 195.52, "discounted_cash": 117.31, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE STONE RETRIEVAL 120CM 1.9FR DAKOTA NTNL 3", "code_information": [{"code": "M0063905000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 499.12, "discounted_cash": 299.47, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUCTION REG CAPACITY TIP FLEXI-CLR WITHOUT CONTROL VENT", "code_information": [{"code": "CFK61", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.54, "discounted_cash": 0.92, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SURG SUT ASSISTANT ENDO LF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SW100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 508.96, "discounted_cash": 305.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUT 15CM 14G TROC SITE FACIA", "code_information": [{"code": "PC-120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.14, "discounted_cash": 51.08, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURE CAPIO SLIM SYSTEM", "code_information": [{"code": "M0068318250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1178.38, "discounted_cash": 707.03, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURE CAPTURING CPIO CL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "M0068311350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2786.11, "discounted_cash": 1671.67, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURE PASSER 45DEG RIGHT CHAMPION SLINGSHOT", "code_information": [{"code": "CAT02855", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 731.5, "discounted_cash": 438.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURE RETRIEVER HOFFEE STERILE 710000", "code_information": [{"code": "710000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 187.2, "discounted_cash": 112.32, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURE STITCH ENDOSCOPIC 10MM 173016", "code_information": [{"code": "173016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.42, "discounted_cash": 240.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURING 10MM REPROCESS ENDO STITCH DISP", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "173016R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 359.88, "discounted_cash": 215.93, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURING 5MM W/ STPCCK VALVE FOR USE W/ VERSAPORT RT REUSABLE CANNULA AND", "code_information": [{"code": "175770", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 113.57, "discounted_cash": 68.14, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURING FIXATE AUTOMATIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FB-101-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5122.0, "discounted_cash": 3073.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURING M CONNECTOR SHOUDLER REQUIRES OM 8000 OPUS SMARTSTITCH STRL DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OM-8007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 418.0, "discounted_cash": 250.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURING SPEEDSTITCH OPUS", "code_information": [{"code": "OM-8086", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 796.56, "discounted_cash": 477.94, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TISSUE CTRL 1 36X36 1/2 CIR TPR SXPD2B405", "code_information": [{"code": "SXPD2B405", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 96.71, "discounted_cash": 58.03, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TISSUE CTRL 2-0 24X24 3/8 CIR REV SXPD2B419", "code_information": [{"code": "SXPD2B419", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 101.86, "discounted_cash": 61.12, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TISSUE CTRL 3-0 30X30 3/8 CIR REV SXMD2B412", "code_information": [{"code": "SXMD2B412", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.44, "discounted_cash": 63.26, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TISSUE CTRL 3-0 7X7 STRATAFIX SXMD2B404", "code_information": [{"code": "SXMD2B404", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.37, "discounted_cash": 42.82, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TISSUE CTRL 4-0 14X14 3/8 CIR REV SXMD2B407", "code_information": [{"code": "SXMD2B407", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.32, "discounted_cash": 49.99, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TISSUE CTRL 4-0 30X30 3/8 CIR REV SXMD2B409", "code_information": [{"code": "SXMD2B409", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 107.23, "discounted_cash": 64.34, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TISSUE REMOVAL MYOSURE REACH", "code_information": [{"code": "10-403FC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2005.2, "discounted_cash": 1203.12, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TITAN NARROW SCROTAL ZERO ANGLE 18CM EN8918", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "EN8918", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 21464.0, "discounted_cash": 12878.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TONSILLECTOMY BIZACT SEALER BZ4212A", "code_information": [{"code": "BZ4212A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 738.34, "discounted_cash": 443.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TRABEX GONIOTOMY 600042-01", "code_information": [{"code": "600042-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1194.34, "discounted_cash": 716.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TRUCLEAR INCISOR PLUS 7209509", "code_information": [{"code": "7209509", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 651.7, "discounted_cash": 391.02, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE UTERINE KIT ABLATION IMPEDANCE CONTROL HANDLE ENDOMETRIUM NOVASURE DISPOSABLE BLUE MANUAL NS2", "code_information": [{"code": "NS2013US", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1836.0, "discounted_cash": 1101.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE V-LOC 90 ABS CLOS 3-0 CL 18 P VLOCM0024", "code_information": [{"code": "VLOCM0024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.6, "discounted_cash": 120.36, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE VLOC 180 ABS 0 GREEN GS25 24I VLOCL0436", "code_information": [{"code": "VLOCL0436", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 138.43, "discounted_cash": 83.06, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE VLOC 180 ABS 2-0 CL 24 P-14 VLOCL0135", "code_information": [{"code": "VLOCL0135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.01, "discounted_cash": 78.61, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE VLOC PBT NON-AB 0 BLUE 18 GS-22 VLOCN1126", "code_information": [{"code": "VLOCN1126", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 108.64, "discounted_cash": 65.18, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE VLOCK  WOUND CLOSURE  1/2 CIRCLE VLOCN0306", "code_information": [{"code": "VLOCN0306", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 173.18, "discounted_cash": 103.91, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE WC VLOC 180 0 GR 6 GS-21 VLOCL0306", "code_information": [{"code": "VLOCL0306", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 173.18, "discounted_cash": 103.91, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE WOUND CLOSER 3-0 GR 6 V-20 V-LOC VLOCL0604", "code_information": [{"code": "VLOCL0604", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 173.18, "discounted_cash": 103.91, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE WOUND CLOSURE V-LOC VLOCN0604", "code_information": [{"code": "VLOCN0604", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 102.26, "discounted_cash": 61.36, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE XPRESS LOPROFILE 6MM COMPACT W/ LIGHT DISP", "code_information": [{"code": "LPLF-206", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3240.0, "discounted_cash": 1944.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICEINFLATION BLLN SINUS RELIEVA", "code_information": [{"code": "BID30", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 235.58, "discounted_cash": 141.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVISE BOWEL POUCH", "code_information": [{"code": "44316", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE 10MG/ML PF SOL", "code_information": [{"code": "MED0602", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 14.06, "discounted_cash": 8.44, "setting": "both", "billing_class": "facility"}]}, {"description": "DEXAMETHASONE 2MG/0.5ML", "code_information": [{"code": "MED0446", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.09, "discounted_cash": 2.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DEXAMETHASONE PANEL", "code_information": [{"code": "80420", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 589.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1184.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1184.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1247.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1122.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 835.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 474.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 402.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE/DECADRON 10MG/1ML VIAL", "code_information": [{"code": "MED0070", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.43, "discounted_cash": 3.26, "setting": "both", "billing_class": "facility"}]}, {"description": "DEXAMETHASONE/DECADRON 4 MG/1ML 1ML VIAL", "code_information": [{"code": "MED0071", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.71, "discounted_cash": 2.83, "setting": "both", "billing_class": "facility"}]}, {"description": "DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPHTH. SUSP. 0.1% 5ML", "code_information": [{"code": "MED0618", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 76.5, "discounted_cash": 45.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DEXAMETHASONE/NEOMYCIN/POLYMYXIN B OPTH OINTMENT 3.5 GM", "code_information": [{"code": "MED0372", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 86.98, "discounted_cash": 52.19, "setting": "both", "billing_class": "facility"}]}, {"description": "DEXMEDETOMIDINE HCL 100MCG/ML", "code_information": [{"code": "MED0344", "type": "CDM"}], "standard_charges": [{"gross_charge": 57.7, "discounted_cash": 34.62, "setting": "both", "billing_class": "facility"}]}, {"description": "DEXTROAMPHETAMINE", "code_information": [{"code": "S0160", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEXTROSE 10% IN WATER IV SOLUTION 500 ML", "code_information": [{"code": "2B0163Q", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 16.32, "discounted_cash": 9.79, "setting": "both", "billing_class": "facility"}]}, {"description": "DEXTROSE 5% IN H2O IV SOL 100ML", "code_information": [{"code": "MED0386", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 50.53, "discounted_cash": 30.32, "setting": "both", "billing_class": "facility"}]}, {"description": "DEXTROSE 5% IN WATER IV SOL 100 ML", "code_information": [{"code": "2B0087", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 402.46, "discounted_cash": 241.48, "setting": "both", "billing_class": "facility"}]}, {"description": "DEXTROSE 5% IN WATER SOLN 50 ML", "code_information": [{"code": "2B0086", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 5.18, "discounted_cash": 3.11, "setting": "both", "billing_class": "facility"}]}, {"description": "DEXTROSE 5% WITH 0.225% NACL IV SOL 500 ML", "code_information": [{"code": "2B1093Q", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 5.12, "discounted_cash": 3.07, "setting": "both", "billing_class": "facility"}]}, {"description": "DEXTROSE 50% 3ML", "code_information": [{"code": "MED0271", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.57, "discounted_cash": 7.54, "setting": "both", "billing_class": "facility"}]}, {"description": "DGP ANTIBODY EACH IG CLASS", "code_information": [{"code": "86258", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": 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DALLAS", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SLD LEVEL V", "code_information": [{"code": "754T", "type": "CPT"}], "standard_charges": [{"minimum": 5.91, "maximum": 12.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 11.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 12.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SLD LEVEL VI", "code_information": [{"code": "755T", "type": "CPT"}], "standard_charges": [{"minimum": 5.91, "maximum": 12.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 11.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 12.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SLD LVL III", "code_information": [{"code": "752T", "type": "CPT"}], "standard_charges": [{"minimum": 5.91, "maximum": 12.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 11.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 12.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SLD SPC GRPI", "code_information": [{"code": "756T", "type": "CPT"}], "standard_charges": [{"minimum": 5.91, "maximum": 12.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 11.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 12.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP XM ARCH TISS", "code_information": [{"code": "847T", "type": "CPT"}], "standard_charges": [{"minimum": 5.91, "maximum": 12.5, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 11.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 12.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 8.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DI GNOTYP SLC4A1 EXON 19", "code_information": [{"code": "183U", "type": "CPT"}], "standard_charges": [{"minimum": 460.94, "maximum": 542.31, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 542.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 460.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIABETES WITH CC", "code_information": [{"code": "638", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6401.95, "maximum": 10402.88, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10402.88, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6401.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIABETES WITH MCC", "code_information": [{"code": "637", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10138.74, "maximum": 16517.35, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 16517.35, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10138.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIABETES WITHOUT CC/MCC", "code_information": [{"code": "639", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4638.15, "maximum": 7106.9, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7106.9, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4638.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAG BRONCHOSCOPE/CATHETER", "code_information": [{"code": "31643", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY", "code_information": [{"code": "46601", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY & BIOPSY", "code_information": [{"code": "46607", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 9519.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC LARYNGOSCOPY", "code_information": [{"code": "31505", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIALATOR 1 ES 2", "code_information": [{"code": "48281000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1932.64, "discounted_cash": 1159.58, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALATOR 2 ES 2", "code_information": [{"code": "48282000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2311.59, "discounted_cash": 1386.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALATOR 3 ES 2", "code_information": [{"code": "48280091", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2311.59, "discounted_cash": 1386.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALATOR BALLOON NEPHROSTOMY ULTRAXX 10MM", "code_information": [{"code": "G30365", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 785.23, "discounted_cash": 471.14, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALATOR BALLOON SINUS XPRESS ULTRA 6MM X 20MM", "code_information": [{"code": "ULF-106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1509.84, "discounted_cash": 905.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALATOR RENAL AMPLATZ GRADUATED 8F-30F X 35CM", "code_information": [{"code": "M0062601000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 557.86, "discounted_cash": 334.72, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALATORINSULATED SMINSTR", "code_information": [{"code": "9450070", "type": "CDM"}], "standard_charges": [{"gross_charge": 309.71, "discounted_cash": 185.83, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALYSIS CIRCUIT EMBOLJ", "code_information": [{"code": "36909", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAMOND BURR 3MM 62380104", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62380104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 625.1, "discounted_cash": 375.06, "setting": "both", "billing_class": "facility"}]}, {"description": "DIAMOND OVAL BURR 4.0MM 62380114", "code_information": [{"code": "62380114", "type": "CDM"}], 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"MED0741", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 129.93, "discounted_cash": 77.96, "setting": "both", "billing_class": "facility"}]}, {"description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [{"code": "375", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8857.18, "maximum": 13935.92, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13935.92, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8857.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [{"code": "374", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15157.1, "maximum": 23947.5, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 23947.5, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 15157.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIGESTIVE MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "376", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6721.24, "maximum": 10014.99, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10014.99, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6721.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIGIT NERVE SURGERY ADD-ON", "code_information": [{"code": "64778", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 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"standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 33.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 66.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 66.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 69.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 62.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 46.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 85.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 72.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILAT IC VSPSM EA DIFF TER", "code_information": [{"code": "61642", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILAT IC VSPSM EA VSL SM TER", "code_information": [{"code": "61641", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATATION URETHRAL STRICTURE BY SOUND OR DILATOR-MALE/SUBSEQUENT 53601", "code_information": [{"code": "53601", "type": "CPT"}, {"code": "1480649", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF ANAL SPHINCTER", "code_information": [{"code": "45905", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 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"discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR 10MM/1.8MM 03.610.001", "code_information": [{"code": "3.610.001", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.66, "discounted_cash": 719.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR 14 X 16MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "16.7013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR 14 X 17MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "16.7014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR 14MM TO 16MM POLY", "code_information": [{"code": "CUS.016.008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 997.5, "discounted_cash": 598.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR 14MM TO 16MM POLYMER", "code_information": [{"code": "14.0-16.0", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1620.0, "discounted_cash": 972.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR 16MM/13MM  03.610.003", "code_information": [{"code": "3.610.003", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.66, "discounted_cash": 719.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR 19MM 03.610.008", "code_information": [{"code": "3.610.008", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.66, "discounted_cash": 719.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR 19MM/16MM  03.610.004", "code_information": [{"code": "3.610.004", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.66, "discounted_cash": 719.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR AMPLATZ TYPE RENAL DILATOR 10F X 35CM", "code_information": [{"code": "M0062601020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 143.1, "discounted_cash": 85.86, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR BALLOON PASSPORT 12FR X 4CM", "code_information": [{"code": "M0062181100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 687.64, "discounted_cash": 412.58, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR BALLOON PASSPORT 12FR X4CM 4CM TIP", "code_information": [{"code": "M0062181110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 687.64, "discounted_cash": 412.58, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR DEFINITY CERVICAL 7MM DCD-701", "code_information": [{"code": "DCD-701", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.64, "discounted_cash": 405.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR DEPUY-ACRO/MOT INST NO DISC (PK PR) - INS. 8 13 18 M MLD-0441S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MLD-0441S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2757.3, "discounted_cash": 1654.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR HEALICOIL 5.5MM REGEN THREADED", "code_information": [{"code": "72203952", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 560.2, "discounted_cash": 336.12, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR KIT SAFEOP STIMULATING STERILE - OVAL AIX1335-S", "code_information": [{"code": "AIX1335-S", "type": "CDM"}, {"code": "272", "type": "RC"}], 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PATHFINDER NXT", "code_information": [{"code": "3554-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 142.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR SZ 19 38-DILATOR-S-19", "code_information": [{"code": "38-DILATOR-S-19", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 284.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR SZ 22 38-DILATOR-S-22", "code_information": [{"code": "38-DILATOR-S-22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 284.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATORINSULATED LG DISP", "code_information": [{"code": "8675424", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 383.94, "discounted_cash": 230.36, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATORS AMPLATZ RENAL", "code_information": [{"code": "M0062602500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.66, "discounted_cash": 276.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DIMETHYL SULFOXIDE 50% IRR SOL 50ML (MEDID)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1212", "type": "HCPCS"}, {"code": "MED0369", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1117.89, "discounted_cash": 670.73, "setting": "both", "billing_class": "facility"}]}, {"description": "DIMETHYL SULFOXIDE 50% IRR SOL 50ML (MEDID)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1212", "type": "HCPCS"}, {"code": "MED0369", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 1117.89, "discounted_cash": 670.73, "setting": "both", "billing_class": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 143.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 129.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 96.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 44.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 37.87, "methodology": "fee schedule"}], 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8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISKECTOMY, ANTERIOR, WITH D", "code_information": [{"code": "S2351", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": 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{"description": "DISSECTOR BALLOON TROCAR SPACEMAKER", "code_information": [{"code": "OMSXB2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 668.59, "discounted_cash": 401.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR ENDO 10-12MM SPACEMAKER BBT OVAL BALLOON", "code_information": [{"code": "SMBTTOVL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1133.53, "discounted_cash": 680.12, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR ENDO 5 MM 36 CM ROTIC W/ UNIVERSAL CAUTERY RATCHET HANDLE", "code_information": [{"code": "174213", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 582.97, "discounted_cash": 349.78, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR ENDOPATH BLUNT TIP 3/PK BTD05", "code_information": [{"code": "BTD05", "type": "CDM"}, {"code": "272", "type": "RC"}], 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"plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOLASETRON MESYLATE ORAL", "code_information": [{"code": "Q0180", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", 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[{"gross_charge": 360.0, "discounted_cash": 216.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DOME TALAR  INVISION SZ1 60012001", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "60012001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7443.8, "discounted_cash": 4466.28, "setting": "both", "billing_class": "facility"}]}, {"description": "DOME TALAR SIZE 2 INFINITY ANKLE SYSTEM 33680022", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "33680022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8970.0, "discounted_cash": 5382.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY LAPS LIV", "code_information": [{"code": "666T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY OPEN CDVR", "code_information": [{"code": "664T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY OPEN LIV", "code_information": [{"code": "665T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY RCP UTER", "code_information": [{"code": "667T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DONOR LOBECTOMY (LUNG)", "code_information": [{"code": "S2061", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DONOR PANCREATECTOMY", "code_information": [{"code": "48550", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DONOR PNEUMONECTOMY", "code_information": [{"code": "32850", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DONUT HEAD 9 FOAM POSITIONER FP-HEAD9", "code_information": [{"code": "FP-HEAD9", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 6.16, "discounted_cash": 3.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DOPAMINE 80 MG/100 ML-D5W IV SOL 500 ML", "code_information": [{"code": "2B0833", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 48.23, "discounted_cash": 28.94, "setting": "both", "billing_class": "facility"}]}, {"description": "DOPPLER COLOR FLOW ADD-ON", "code_information": [{"code": "93325", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOPPLER ECHO EXAM HEART", "code_information": [{"code": "93320", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOPPLER ECHO EXAM HEART", "code_information": [{"code": "93321", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOPPLER FLOW TESTING", "code_information": [{"code": "93990", "type": "CPT"}], "standard_charges": [{"minimum": 397.64, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", 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4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN EVACUATED TUBE ROUND SILICONE 10FR DYNJWE0321", "code_information": [{"code": "DYNJWE0321", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.9, "discounted_cash": 32.94, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN FLAT SILICONE 10MMX20CM FULL PERF 0070440", "code_information": [{"code": "70440", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.1, "discounted_cash": 16.26, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN FLUTE WITH TROCAR FULL ROUND 15FR", "code_information": [{"code": "B072189", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.56, "discounted_cash": 41.14, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN MALECOT 4-WING 30 FR LATEX 086030", "code_information": [{"code": "86030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.13, "discounted_cash": 33.08, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN OPEN ABDOM ABSCESS", "code_information": [{"code": "49040", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN LUNG LESION", "code_information": [{"code": "32200", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN RETROPERI ABSCESS", "code_information": [{"code": "49060", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN OUTER EAR CANAL LESION", "code_information": [{"code": "69020", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN OVARY ABSCESS PERCUT", "code_information": [{"code": "58822", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN PENROSE .25IN STERILE 30416-025", "code_information": [{"code": "30416-025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.24, "discounted_cash": 3.14, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE .5IN X 12IN OPEN WOUND CARE DRAINAGE LATEX STRL", "code_information": [{"code": "912030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.18, "discounted_cash": 0.11, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE 1/2 X 18IN PIN", "code_information": [{"code": "20416-050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.57, "discounted_cash": 2.14, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE 1/2IN X 18ININCISION CLOSED WOUND DRAINAGE WOUND CARE LTX STRL", "code_information": [{"code": "DYND50422", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.33, "discounted_cash": 2.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE 1/4IN 12IN LNG LF STRL", "code_information": [{"code": "912010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.05, "discounted_cash": 1.23, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE 1/4X 12  ST", "code_information": [{"code": "DC91201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.96, "discounted_cash": 2.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE 12X1 4 1 EACH", "code_information": [{"code": "30414-025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.42, "discounted_cash": 2.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE 36IN X .50IN GRAVITY DRAIN FLAT NON STRL", "code_information": [{"code": "97900", "type": "CDM"}], "standard_charges": [{"gross_charge": 8.25, "discounted_cash": 4.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE DRAIN 18X1 2 067 STAND 30416-050", "code_information": [{"code": "30416-050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.41, "discounted_cash": 3.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN RESERVOIR 100CC CLR EVACUATOR BULB JACKSON-PRATT SILICONE 70740 (USE 0070740 PART NUMBER)", "code_information": [{"code": "70740 (USE 0070740 PART NUMBER)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.48, "discounted_cash": 14.69, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN RND HUBLESS 10FR FLUTED TROCAR 072227", "code_information": [{"code": "72227", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.87, "discounted_cash": 40.12, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN ROUND 3/32IN END PERFORATED SILICONE", "code_information": [{"code": "70200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.56, "discounted_cash": 15.34, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN ROUND CHANNEL TROCAR 15FR 072189", "code_information": [{"code": "72189", "type": "CDM"}], "standard_charges": [{"gross_charge": 75.54, "discounted_cash": 45.32, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN ROUND CHANNEL TROCAR 15FR 072189", "code_information": [{"code": "72189", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.56, "discounted_cash": 41.14, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER BONE LESION", "code_information": [{"code": "23035", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN SILCN BLAKE 10FR ROUND 1 8 TRC LF 2227", "code_information": [{"code": "2227", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 326.52, "discounted_cash": 195.91, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN SILICONE ROUND 1 8 END PERF 0070310", "code_information": [{"code": "70310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.7, "discounted_cash": 25.02, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN SPINAL 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{"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE ABDOM ABSCESS OPEN", "code_information": [{"code": "49020", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee 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"plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE EXTERNAL EAR ABSCESS OR HEMATOMA COMPLICATED 69005", "code_information": [{"code": "69005", "type": "CPT"}, {"code": "1480668", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE EXTERNAL EAR ABSCESS OR HEMATOMA SIMPLE 69000", "code_information": [{"code": "69000", "type": "CPT"}, {"code": "1480669", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF ABCESS/CYST/HEMATOMA MOUTH-SIMPLE 40800", "code_information": [{"code": "40800", "type": "CPT"}, {"code": "1480670", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF ABDOMEN", "code_information": [{"code": "48000", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF ABSCESS CYST/HEMATOMA VESTIBULE OF THE MOUTH COMPLICATED 40801", "code_information": [{"code": "40801", "type": "CPT"}, {"code": "2401819", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee 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"code_information": [{"code": "42300", "type": "CPT"}, {"code": "42695233", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BLADDER ABSCESS", "code_information": [{"code": "51080", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "21510", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "26992", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYELID ABSCESS", "code_information": [{"code": "67700", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF KIDNEY LESION", "code_information": [{"code": "50390", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41000", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41006", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41018", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, 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HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF NOSE LESION", "code_information": [{"code": "30020", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF OVARIAN CYST(S)", "code_information": [{"code": "58805", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF OVARIAN CYST(S) UNILATERAL OR BILATERAL VAGINAL APPROACH 58800", "code_information": [{"code": "58800", "type": "CPT"}, {"code": "2042286", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 10356.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIC ABSCESS", "code_information": [{"code": "45000", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42310", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42320", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SCROTAL WALL ABSCESS 55100", "code_information": [{"code": "55100", "type": "CPT"}, {"code": "1480671", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SPINAL CYST", "code_information": [{"code": "63172", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SPINAL CYST", "code_information": [{"code": "63173", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF THROAT ABSCESS", "code_information": [{"code": "42720", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF THROAT ABSCESS", "code_information": [{"code": "42725", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URETHRA ABSCESS", "code_information": [{"code": "53060", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, 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"plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URINARY LEAKAGE", "code_information": [{"code": "53080", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URINARY LEAKAGE", "code_information": [{"code": "53085", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OR ABCESS CYST HEMATOMA FROM DENTOALVEOLAR STRUCTURE 41800", "code_information": [{"code": "41800", "type": "CPT"}, {"code": "5389350", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE PALMAR BURSA SINGLE 26025", "code_information": [{"code": "26025", "type": "CPT"}, {"code": "1480672", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 101.91, "discounted_cash": 61.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPEINCISE 60CM X 45CM STERI DRP", "code_information": [{"code": "1050steri", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.63, "discounted_cash": 9.98, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPES  SPACE STATION  CDS3060 CDS-3060-DD", "code_information": [{"code": "CDS-3060-DD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 198.4, "discounted_cash": 119.04, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPES SPACE STATION DISPOSABLE CDS-3072-DD", "code_information": [{"code": "CDS-3072-DD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 198.4, "discounted_cash": 119.04, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAW BLOOD OFF VENOUS DEVICE", "code_information": [{"code": "36591", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 245.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 493.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan 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4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRESS/DEBRID P-THICK BURN L", "code_information": [{"code": "16030", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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"facility"}]}, {"description": "DRESSING AG AQUACEL SURGICAL 3.5X9.75 STERILE SILVER", "code_information": [{"code": "412011A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.24, "discounted_cash": 72.14, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING ALL IN ONE FOR ACUTE SURGICAL WOUNDS 14 INCHX4 INCH DISPOSABLE/SNGLE USE STERILE MEPILEX BO", "code_information": [{"code": "158498650", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 152.92, "discounted_cash": 91.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING AQUACEL 3.5IN X 6FT", "code_information": [{"code": "413556", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.31, "discounted_cash": 54.19, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING AQUAGUARD 10X12 W SPRAY BAR 50011-00", "code_information": [{"code": "50011-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.49, "discounted_cash": 50.09, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING AVANCE SOLO 10 X 20CM (4 X 8IN) 881020", "code_information": [{"code": "881020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 163.9, "discounted_cash": 98.34, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING AVANCE SOLO 10 X 30CM (4 X 12IN) 881030", "code_information": [{"code": "881030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.73, "discounted_cash": 101.84, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING AVANCE SOLO 10 X 35CM (4 X 14IN) 881035", "code_information": [{"code": "881035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 178.26, "discounted_cash": 106.96, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING BIOPATCH 1 DISK CHG 7MM CENTER 4152", "code_information": [{"code": "4152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.08, "discounted_cash": 21.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING BIOPATCH CHG 0.75 DISK 1.5MM CENTER 4151", "code_information": [{"code": "4151", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.08, "discounted_cash": 21.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING BIOPATCH CHG DISC 1\" 4MM HOLE 4150", "code_information": [{"code": "4150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.36, "discounted_cash": 21.22, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING BORDERMEPILEXPOSTOP AG4X12 498600", "code_information": [{"code": "498600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 118.14, "discounted_cash": 70.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING BRDR MEPILEX PST OP AG 4X8 498400", "code_information": [{"code": "498400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 107.34, "discounted_cash": 64.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING CANISTER 50ML AVANCE SOLO  880050", "code_information": [{"code": "880050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.19, "discounted_cash": 84.11, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING CENTRAL LINE TRAY W/CHLORAPREP DYND75225H", "code_information": [{"code": "DYND75225H", "type": "CDM"}], "standard_charges": [{"gross_charge": 18.48, "discounted_cash": 11.09, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING COVER 3.5 CM X 6 CM SURG AQUACEL", "code_information": [{"code": "412010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.31, "discounted_cash": 56.59, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING COVER SURGI AQUACEL AG 3.5X10", "code_information": [{"code": "412011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 113.3, "discounted_cash": 67.98, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING DEGRADING BIORESORBABLE NASAL", "code_information": [{"code": "5400-020-108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 786.32, "discounted_cash": 471.79, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING DERMAGEL WAFFER 4IN X 4IN", "code_information": [{"code": "NON8000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.8, "discounted_cash": 13.08, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING DUODERM 2IN X 4IN CGF EXTRA THIN", "code_information": [{"code": "1879-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.48, "discounted_cash": 4.49, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING DUODERM EXTRA THIN 3IN X 3IN", "code_information": [{"code": "187901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.77, "discounted_cash": 5.86, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING EYE 1 5/8IN X 2 5/8IN OVAL NONADHERENT COTTON CURITY LF STRL", "code_information": [{"code": "2841", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 0.91, "discounted_cash": 0.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING EYE 2 5/8 X 1 5/8IN SURECARE LF COTTON MESH ABSORB STERILE", "code_information": [{"code": "82911", "type": 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{"description": "DRESSING GAUZE XEROFORM CURAD 1X8 ST CUR253180", "code_information": [{"code": "CUR253180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.16, "discounted_cash": 1.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING GAUZE XEROFORM CURAD 5X9 ST CUR253590", "code_information": [{"code": "CUR253590", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.08, "discounted_cash": 1.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING GAUZE XEROFORM PETRO 1X8", "code_information": [{"code": ".", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.94, "discounted_cash": 1.16, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING GERMICIDAL AQUACEL HYDROFIBER/GEL SILVER 3.5X10IN STR 422605", "code_information": [{"code": "422605", "type": "CDM"}, {"code": "272", "type": "RC"}], 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"standard_charge_dollar": 223.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 223.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 235.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 211.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 157.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 52.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 44.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 1-7 CLASSES", "code_information": [{"code": "G0480", "type": "HCPCS"}], "standard_charges": [{"minimum": 284.8, "maximum": 335.08, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 335.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 284.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 15-21 CLASSES", "code_information": [{"code": "G0482", "type": "HCPCS"}], "standard_charges": [{"minimum": 494.63, "maximum": 581.96, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 581.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 494.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 22+ CLASSES", "code_information": [{"code": "G0483", "type": "HCPCS"}], "standard_charges": [{"minimum": 614.55, "maximum": 723.05, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 723.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 614.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 8-14 CLASSES", "code_information": [{"code": "G0481", "type": "HCPCS"}], "standard_charges": [{"minimum": 389.72, "maximum": 458.52, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 458.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 389.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF SIMPLE ALL CL", "code_information": [{"code": "G0659", "type": "HCPCS"}], "standard_charges": [{"minimum": 154.65, "maximum": 181.96, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 181.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 154.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG/BIO NOC PART B DRUG CAP", "code_information": [{"code": "Q4082", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG/SUBSTANCE NOS 1-3", "code_information": [{"code": "80375", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 216.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 435.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 435.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 457.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 412.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 306.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG/SUBSTANCE NOS 4-6", "code_information": [{"code": "80376", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG/SUBSTANCE NOS 7/MORE", "code_information": [{"code": "80377", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 297.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 297.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 312.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 281.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 209.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRY CRUSHED CANCELLOUS CHIPS 100015", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "100015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 340.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRY CRUSHED CANCELLOUS CHIPS 30CC 100030", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "100030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1130.88, "discounted_cash": 678.53, "setting": "both", "billing_class": "facility"}]}, {"description": "DRY CUBED CANCELLOUS CHIPS 30CC 100330", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "100330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1134.0, "discounted_cash": 680.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DS SWIVELOCK SL 3.5 X 8.5 W/ FORK EYELET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8978P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1824.0, "discounted_cash": 1094.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G .5 /<", "code_information": [{"code": "17270", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 9519.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 0.6-1", "code_information": [{"code": "17271", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 1.1-2", "code_information": [{"code": "17272", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 2.1-3", "code_information": [{"code": "17273", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 3.1-4", "code_information": [{"code": "17274", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G >4.0", "code_information": [{"code": "17276", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M .5/<", "code_information": [{"code": "17280", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M .6-1", "code_information": [{"code": "17281", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M1.1-2", "code_information": [{"code": "17282", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M2.1-3", "code_information": [{"code": "17283", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M3.1-4", "code_information": [{"code": "17284", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M>4.0", "code_information": [{"code": "17286", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ LESION LID MARGIN <1CM", "code_information": [{"code": "67850", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L .6-1.0CM", "code_information": [{"code": "17261", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 0.5 CM/<", "code_information": [{"code": "17260", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 1.1-2.0", "code_information": [{"code": "17262", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 2.1-3.0", "code_information": [{"code": "17263", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 3.1-4.0", "code_information": [{"code": "17264", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L >4.0 CM", "code_information": [{"code": "17266", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ NEUROFIBROMA XTNSV", "code_information": [{"code": "419T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", 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"standard_charges": [{"gross_charge": 1892.16, "discounted_cash": 1135.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DTS GUIDE AWL  ADJUSTABLE DEPTH 6105.401", "code_information": [{"code": "6105.401", "type": "CDM"}], "standard_charges": [{"gross_charge": 1244.16, "discounted_cash": 746.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DTS GUIDE TAP  ADJUSTABLE DEPTH 6105.403", "code_information": [{"code": "6105.403", "type": "CDM"}], "standard_charges": [{"gross_charge": 1244.16, "discounted_cash": 746.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DUAL HOLE STAPLE  CAUDAL  L 187701006S", "code_information": [{"code": "187701006S", "type": "CDM"}], "standard_charges": [{"gross_charge": 1581.12, "discounted_cash": 948.67, "setting": "both", "billing_class": "facility"}]}, {"description": "DUAL HOLE STAPLE  CAUDAL  M 187701004S", "code_information": [{"code": "187701004S", "type": "CDM"}], "standard_charges": 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5.5-4.5 X 20MM 6119.0033", "code_information": [{"code": "6119.0033", "type": "CDM"}], "standard_charges": [{"gross_charge": 1202.32, "discounted_cash": 721.39, "setting": "both", "billing_class": "facility"}]}, {"description": "DUAL OUTER DIAMETER TAP 5.5-4.5 X 35MM 6119.0034", "code_information": [{"code": "6119.0034", "type": "CDM"}], "standard_charges": [{"gross_charge": 1202.32, "discounted_cash": 721.39, "setting": "both", "billing_class": "facility"}]}, {"description": "DUAL OUTER DIAMETER TAP 6.0-5.0 X 20MM 6119.0043", "code_information": [{"code": "6119.0043", "type": "CDM"}], "standard_charges": [{"gross_charge": 1202.32, "discounted_cash": 721.39, "setting": "both", "billing_class": "facility"}]}, {"description": "DUAL OUTER DIAMETER TAP 6.0-5.0 X 35MM 6119.0044", "code_information": [{"code": "6119.0044", "type": "CDM"}], "standard_charges": [{"gross_charge": 1202.32, "discounted_cash": 721.39, "setting": "both", "billing_class": "facility"}]}, {"description": "DUAL OUTER 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"DUAL RAIL CHIN PLATES 2MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "Jan-72", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 957.0, "discounted_cash": 574.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DUAL-SIDED RASP BAYONETED 03.605.507", "code_information": [{"code": "3.605.507", "type": "CDM"}], "standard_charges": [{"gross_charge": 2023.92, "discounted_cash": 1214.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DUO CORTICAWL BONE PILOT SMI006501", "code_information": [{"code": "SMI006501", "type": "CDM"}], "standard_charges": [{"gross_charge": 297.04, "discounted_cash": 178.22, "setting": "both", "billing_class": "facility"}]}, {"description": "DUODENAL EXCLUSION", "code_information": [{"code": "48547", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUODENAL MOTILITY STUDY", "code_information": [{"code": "91022", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 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"standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUP-SCAN HEMO COMPL BI STD", "code_information": [{"code": "93985", "type": "CPT"}], "standard_charges": [{"minimum": 868.84, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1022.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 868.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUP-SCAN HEMO COMPL UNI STD", "code_information": [{"code": "93986", "type": "CPT"}], "standard_charges": [{"minimum": 397.64, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUPLOSPRAY MIS APPLICATOR WITH SNAP LOCK 30CM", "code_information": [{"code": "601129", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 273.15, "discounted_cash": 163.89, "setting": "both", "billing_class": "facility"}]}, {"description": "DUPLOTIP APPLICATOR WITH SNAP LOCK RIGID 5MM X 40CM", "code_information": [{"code": "601139", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 182.57, "discounted_cash": 109.54, "setting": "both", "billing_class": "facility"}]}, {"description": "DURA GUARD MATRIX 4CMX4CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "DG-0404SN", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1040.75, "discounted_cash": 624.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DURA GUARD MATRIX CMX2CM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "DG-02-09SN", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1059.46, "discounted_cash": 635.68, "setting": "both", "billing_class": "facility"}]}, {"description": "DURAL GRAFT SPINAL 63710", "code_information": [{"code": "63710", "type": "CPT"}, {"code": "1700068", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF 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"code_information": [{"code": "MED0423", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 54.59, "discounted_cash": 32.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DURASEAL", "code_information": [{"code": "MED0075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.13, "discounted_cash": 6.08, "setting": "both", "billing_class": "facility"}]}, {"description": "DX ALY AUD OI SND PRCSR 1ST", "code_information": [{"code": "92622", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX ALY AUD OI SND PRCSR EACH", "code_information": [{"code": "92623", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX BONE MARROW BIOPSIES", "code_information": [{"code": "38221", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX BONE MARROW BX & ASPIR", "code_information": [{"code": "38222", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3330.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4892.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6688.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6336.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4717.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX BRONCH W/ NAVIGATION", "code_information": [{"code": "C7509", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX BRONCHOSCOPE/BRUSH", "code_information": [{"code": "31623", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", 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7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX BRONCHOSCOPE/LAVAGE", "code_information": [{"code": "31624", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee 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"plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX DARK ADAPTATION EXAM I&R", "code_information": [{"code": "92284", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX DUOD INTUB W/ASP SPEC", "code_information": [{"code": "43756", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for 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CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee 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"standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX FIBERTAK DISPOSABLES KIT", "code_information": [{"code": "AR-8990DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 792.95, "discounted_cash": 475.77, "setting": "both", "billing_class": "facility"}]}, {"description": "DX GASTR INTUB W/ASP SPEC", "code_information": [{"code": "43754", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX INTRAOP EPCAR US CHD I&R", "code_information": [{"code": "76989", "type": "CPT"}], "standard_charges": [{"minimum": 343.75, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 343.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 690.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 690.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 726.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 654.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 486.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX INTRAOP EPICAR CAR US CHD", "code_information": [{"code": "76987", "type": "CPT"}], "standard_charges": [{"minimum": 343.75, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 343.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 690.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 690.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 726.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 654.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 486.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX INTRAOP THORACIC AORTA US", "code_information": [{"code": "76984", "type": "CPT"}], "standard_charges": [{"minimum": 343.75, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 343.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 690.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 690.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 726.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 654.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 486.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX LARYNGOSCOPY NEWBORN", "code_information": [{"code": "31520", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX LMBR SPI PNXR W/FLUOR/CT", "code_information": [{"code": "62328", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX MAMMO INCL CAD BI", "code_information": [{"code": "77066", "type": "CPT"}], "standard_charges": [{"minimum": 134.08, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 134.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 269.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 269.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 283.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 255.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 189.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 518.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 440.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX MAMMO INCL CAD UNI", "code_information": [{"code": "77065", "type": "CPT"}], "standard_charges": [{"minimum": 109.06, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 109.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 219.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 219.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 230.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 207.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 154.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 406.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 345.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX NTROP EPCR US CHD IMG ACQ", "code_information": [{"code": "76988", "type": "CPT"}], "standard_charges": [{"minimum": 343.75, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 343.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 690.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 690.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 726.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 654.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 486.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DXA BONE DENSITY AXIAL", "code_information": [{"code": "77080", "type": "CPT"}], "standard_charges": [{"minimum": 297.66, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 297.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 597.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 597.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 629.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 566.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 421.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DXA BONE DENSITY STUDY", "code_information": [{"code": "77085", "type": "CPT"}], "standard_charges": [{"minimum": 230.76, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 230.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 463.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 463.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 487.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 439.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 326.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DXA BONE DENSITY/PERIPHERAL", "code_information": [{"code": "77081", "type": "CPT"}], "standard_charges": [{"minimum": 259.68, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 259.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 521.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 521.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 549.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 494.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 367.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 380.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 323.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DXTEND SCREW NO LOCK D4.5X30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "130770030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 288.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DYNACLIP BONE FIXATION SYSTEM 18MM X 20MM X 20MM 3000-00-182020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3000-00-182020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3744.0, "discounted_cash": 2246.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DYNAMIC CAVERNOSOMETRY", "code_information": [{"code": "54231", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYNAMIC FINE WIRE EMG", "code_information": [{"code": "96003", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYNAMIC SURFACE EMG", "code_information": [{"code": "96002", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYSEQUILIBRIUM", "code_information": [{"code": "149", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5219.47, "maximum": 8478.15, "estimated_discounted_cash": 4732.52, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 8478.15, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5219.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dab Irrigation Solution Dr. Lemmon PCN Allergic - 1000 mL (NO CHARGE)", "code_information": [{"code": "MED0646", "type": "CDM"}], 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EASY CATCHER DIPOSABLE SYSTEM", "code_information": [{"code": "O-EC52-A4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.46, "discounted_cash": 57.28, "setting": "both", "billing_class": "facility"}]}, {"description": "EASY CONNECT HANDLE  SMALL 697.705", "code_information": [{"code": "697.705", "type": "CDM"}], "standard_charges": [{"gross_charge": 1425.6, "discounted_cash": 855.36, "setting": "both", "billing_class": "facility"}]}, {"description": "EASYFUSE STAPLE 15 X 12 NITINOL 2 LEG FFS21512", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFS21512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4045.6, "discounted_cash": 2427.36, "setting": "both", "billing_class": 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"standard_charge_dollar": 220.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 443.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 443.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 466.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 173.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 348.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 348.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 367.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 330.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 246.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 102.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 87.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECCENTRIC GLENSPHERE 2MM OFFSET 36MM DWJ032", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWJ032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2520.0, "discounted_cash": 1512.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93224", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 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HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93226", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93227", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG RECORD/REVIEW", "code_information": [{"code": "93268", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG/MONITORING AND ANALYSIS", "code_information": [{"code": "93271", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG/REVIEW INTERPRET ONLY", "code_information": [{"code": "93272", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG/SIGNAL-AVERAGED", "code_information": [{"code": "93278", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHELON FLEX GST 60-3.8MM RELOADS GST60D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GST60D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 475.2, "discounted_cash": 285.12, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO B-MTRC MP FP HO 17", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "193117", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3237.0, "discounted_cash": 1942.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FMRL NC 10X130", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10201.1, "discounted_cash": 6120.66, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FMRL NC 13X145", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10201.1, "discounted_cash": 6120.66, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FMRL NC 7X115", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10201.1, "discounted_cash": 6120.66, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE", "code_information": [{"code": "76516", "type": "CPT"}], "standard_charges": [{"minimum": 103.48, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 103.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 207.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 207.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 218.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 196.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 146.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE", "code_information": [{"code": "76519", "type": "CPT"}], "standard_charges": [{"minimum": 114.97, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 114.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 230.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 230.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 243.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 218.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 162.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE", "code_information": [{"code": "76529", "type": "CPT"}], "standard_charges": [{"minimum": 101.18, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 203.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 203.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 213.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 192.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 143.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 380.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 323.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE THICKNESS", "code_information": [{"code": "76514", "type": "CPT"}], "standard_charges": [{"minimum": 42.23, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 84.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 84.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 89.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 80.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 59.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 109.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 92.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76825", "type": "CPT"}], "standard_charges": [{"minimum": 307.99, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 307.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 618.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 618.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 651.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 586.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 436.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2202.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1871.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76826", "type": "CPT"}], "standard_charges": [{"minimum": 158.43, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 158.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 318.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 318.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 334.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 301.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 224.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1022.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 868.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76827", "type": "CPT"}], "standard_charges": [{"minimum": 158.43, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 158.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 318.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 318.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 334.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 301.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 224.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76828", "type": "CPT"}], "standard_charges": [{"minimum": 65.21, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 130.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 130.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 137.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 124.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 92.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF HEAD", "code_information": [{"code": "76506", "type": "CPT"}], "standard_charges": [{"minimum": 254.34, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 254.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 510.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 510.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 537.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 483.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 360.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM UTERUS", "code_information": [{"code": "76831", "type": "CPT"}], "standard_charges": [{"minimum": 323.26, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 323.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 649.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 649.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 683.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 615.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 457.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1022.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 868.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDANCE RADIOTHERAPY", "code_information": [{"code": "G6001", "type": "HCPCS"}], "standard_charges": [{"minimum": 586.83, "maximum": 690.44, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 690.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 586.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR AMNIOCENTESIS", "code_information": [{"code": "76946", "type": "CPT"}], "standard_charges": [{"minimum": 90.87, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 90.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 182.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 182.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 192.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 172.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 128.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR ARTERY REPAIR", "code_information": [{"code": "76936", "type": "CPT"}], "standard_charges": [{"minimum": 487.48, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 487.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 979.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 979.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1030.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 927.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 690.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1225.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1041.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR HEART BIOPSY", "code_information": [{"code": "76932", "type": "CPT"}], "standard_charges": [{"minimum": 75.9, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 75.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 152.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 152.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 160.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 144.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 107.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR TRANSFUSION", "code_information": [{"code": "76941", "type": "CPT"}], "standard_charges": [{"minimum": 214.17, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 214.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 430.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 430.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 452.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 407.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 303.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE OVA ASPIRATION", "code_information": [{"code": "76948", "type": "CPT"}], "standard_charges": [{"minimum": 37.58, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 75.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 75.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 79.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 71.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 53.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE VILLUS SAMPLING", "code_information": [{"code": "76945", "type": "CPT"}], "standard_charges": [{"minimum": 76.67, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 76.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 153.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 153.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 162.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 145.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 108.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93312", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93313", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93314", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93315", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93316", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93317", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL (TEE)", "code_information": [{"code": "93355", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL INTRAOP", "code_information": [{"code": "93318", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSTHORACIC", "code_information": [{"code": "93303", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSTHORACIC", "code_information": [{"code": "93304", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHOBLOCK 21G X 4IN", "code_information": [{"code": "EBA-21100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.22, "discounted_cash": 37.93, "setting": "both", "billing_class": "facility"}]}, {"description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [{"code": "3", "type": "MS-DRG"}], "standard_charges": [{"minimum": 134302.92, "maximum": 243077.21, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 243077.21, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 134302.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS DAILY MGMT ARTERY", "code_information": [{"code": "33949", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS DAILY MGMT-VENOUS", "code_information": [{"code": "33948", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ CTR CANNULA", "code_information": [{"code": "33956", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, 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SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33953", "type": "CPT"}], 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"standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33954", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33962", 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33963", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PERPH CANNULA", "code_information": [{"code": "33965", "type": "CPT"}], 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"standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PERPH CANNULA", "code_information": [{"code": "33969", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"EEG PHY/QHP>60<84 HR W/VEEG", "code_information": [{"code": "95724", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>84 HR W/O VID", "code_information": [{"code": "95725", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>84 HR W/VEEG", "code_information": [{"code": "95726", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG PHYS/QHP 2-12 HR W/O VID", "code_information": [{"code": "95717", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG PHYS/QHP 2-12 HR W/VEEG", "code_information": [{"code": "95718", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG PHYS/QHP EA INCR W/O VID", "code_information": [{"code": "95719", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID 2-12 HR UNMNTR", "code_information": [{"code": "95705", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID 2-12HR CONT MNTR", "code_information": [{"code": "95707", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID EA 12-26HR CONT", "code_information": [{"code": "95710", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID EA 12-26HR INTMT", "code_information": [{"code": "95709", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EEG WO VID 2-12HR INTMT MNTR", "code_information": [{"code": "95706", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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"plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD BALLOON DIL ESOPH30 MM/>", "code_information": [{"code": "43233", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD CAUTERY TUMOR POLYP", "code_information": [{"code": "43250", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD CONTROL BLEEDING ANY", "code_information": [{"code": "43255", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD ENDO MUCOSAL RESECTION", "code_information": [{"code": "43254", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD ENDOSCOPIC STENT PLACE", "code_information": [{"code": "43266", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD ESOPHAGOGASTRC FNDOPLSTY", "code_information": [{"code": "43210", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL BX 1/MLT", "code_information": [{"code": "653T", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL DX BR/WA", "code_information": [{"code": "652T", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL TUBE/CATH", "code_information": [{"code": "654T", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRNSORL DPLMNT BALO", "code_information": [{"code": "43290", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRNSORL RMVL BALO", "code_information": [{"code": "43291", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD INJECTION VARICES", "code_information": [{"code": "43243", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD LESION ABLATION", "code_information": [{"code": "43270", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD OPTICAL ENDOMICROSCOPY", "code_information": [{"code": "43252", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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"plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43246", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD REMOVE FOREIGN BODY", "code_information": [{"code": "43247", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD TUBE/CATH INSERTION", "code_information": [{"code": "43241", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"facility"}]}, {"description": "EGD US EXAM DUODENUM/JEJUNUM", "code_information": [{"code": "43259", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD US FINE NEEDLE BX/ASPIR", "code_information": [{"code": "43238", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD US FINE NEEDLE BX/ASPIR", "code_information": [{"code": "43242", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD VARICES LIGATION", "code_information": [{"code": "43244", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD VOL ADJMT BARIATRIC BALO", "code_information": [{"code": "813T", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD W/THRML TXMNT GERD", "code_information": [{"code": "43257", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGFR GENE COM VARIANTS", "code_information": [{"code": "81235", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 844.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1697.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1697.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1786.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1607.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1196.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 950.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 807.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EHRLICHA CHAFFEENSIS AMP PRB", "code_information": [{"code": "87484", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 109.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 218.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 218.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 230.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 207.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 154.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 102.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 87.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EHRLICHIA ANTIBODY", "code_information": [{"code": "86666", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 140.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 104.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 29.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 25.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EIA HIV-1/HIV-2 SCREEN", "code_information": [{"code": "G0432", "type": "HCPCS"}], "standard_charges": [{"minimum": 48.7, "maximum": 57.3, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 57.3, "methodology": "fee 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S  CUI8050S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CUI8050S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2860.0, "discounted_cash": 1716.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EKG FOR INITIAL PREVENT EXAM", "code_information": [{"code": "G0403", "type": "HCPCS"}], "standard_charges": [{"minimum": 108.05, "maximum": 228.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 108.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 217.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 217.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 228.46, "methodology": 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0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 94.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 189.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 189.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 199.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 125.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 131.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 118.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 88.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 67.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELCAM FOUR-WAY LARGE BORE POLY 2C6204", "code_information": [{"code": "2C6204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.59, "discounted_cash": 3.95, "setting": "both", "billing_class": "facility"}]}, {"description": "ELEC ALY CPX IINS SP/SAC NRV", "code_information": [{"code": "789T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELEC ALY SMP IINS SP/SAC NRV", "code_information": [{"code": "788T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELEC IMPD SPECTRSC 1+SKN LES", "code_information": [{"code": "658T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELEC. ANALYSIS OF IMPLANTED NEUROSTIM PULSE GEN. SIMPLE OR COMP. 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ANALYSIS OF IMPLANTED NEUROSTIM. PULSE GEN. COMPLEX SPINAL CORD W/PROG. EA ADD 30 MIN 95973", "code_information": [{"code": "3307073", "type": "CDM"}, {"code": "929", "type": "RC"}], "standard_charges": [{"gross_charge": 449.0, "discounted_cash": 269.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ELEC. ANALYSIS OF PROGRAM IMPLANT PUMP FOR INTRATHECAL OR EPI. DRUG INF. 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ANALYSIS OF PROGRAM IMPLANT. 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRIC STIMULATION THERAPY", "code_information": [{"code": "97014", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRICAL BONE STIMULATION", "code_information": [{"code": "20974", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRICAL BONE STIMULATION", "code_information": [{"code": "20975", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRO HEARNG AID TEST ONE", "code_information": [{"code": "92594", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRO HEARNG AID TST BOTH", "code_information": [{"code": "92595", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRO-OCULOGRAPHY W/I&R", "code_information": [{"code": "92270", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRO-UROFLOWMETRY FIRST", "code_information": [{"code": "51741", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROCARDIOGRAM COMPLETE", "code_information": [{"code": "93000", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROCARDIOGRAM REPORT", "code_information": [{"code": "93010", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROCONVULSIVE THERAPY", "code_information": [{"code": "90870", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRODE 26FR ELT ROLLER BALL RSSCP HYSCP BLU", "code_information": [{"code": "RE-26", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 251.66, "discounted_cash": 151.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE 28FR ELT ROLLER BALL RSSCP HYSCP BLU", "code_information": [{"code": "RE-28", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 251.65, "discounted_cash": 150.99, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BALL 13CM 5MM ELECTROSURGICAL PENCIL TIP LLETZ STRL DISP", "code_information": [{"code": "E1564", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 108.83, "discounted_cash": 65.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BALL 37CM 6FR STERILE REUSABLE GREEN BUGBEE 257F6", "code_information": [{"code": "257F6", "type": "CDM"}], "standard_charges": [{"gross_charge": 254.82, "discounted_cash": 152.89, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BALL 3MM BLACK", "code_information": [{"code": "DBL311", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.71, "discounted_cash": 58.63, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BALL 45DEG SM JOINT COOLCUT", "code_information": [{"code": "AR-9808SJ-45", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 438.9, "discounted_cash": 263.34, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BALL 5MM 11CM RED LEEP UTAH BALL", "code_information": [{"code": "DBL-511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.4, "discounted_cash": 46.44, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BIPOLAR NOVASURE", "code_information": [{"code": "NS2000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2052.0, "discounted_cash": 1231.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE 1.1IN COATED", "code_information": [{"code": "E1450X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.99, "discounted_cash": 31.79, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE 2.5 E-Z CLEAN MODIFIED 0012M", "code_information": [{"code": "12M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.57, "discounted_cash": 12.34, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE 4 E-Z CLEAN 0014A", "code_information": [{"code": "14A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.75, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE 4IN .093IN COATED ELECTROSURGICAL EXTENDED LF STRL", "code_information": [{"code": "E14504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.59, "discounted_cash": 33.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE 4IN .093IN COATEDINSULATED EDGE", "code_information": [{"code": "E14554", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.94, "discounted_cash": 41.96, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE 6.5 E-Z CLEAN 0014", "code_information": [{"code": "14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.12, "discounted_cash": 15.67, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BLADE 6.5 E-Z CLEAN 0014M", "code_information": [{"code": "14M", "type": "CDM"}, {"code": "272", "type": "RC"}], 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DFW", "standard_charge_dollar": 38.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 32.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENCEPHALTIS ST LOUIS ANTBODY", "code_information": [{"code": "86653", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 46.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 92.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 92.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 97.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 87.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 65.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 38.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 32.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENCEPHALTIS WEST EQNE ANTBDY", "code_information": [{"code": "86654", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 42.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 84.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 84.44, "methodology": "fee schedule"}, {"payer_name": "BLUE 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 201.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 171.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO CHOLANGIOPANCREATOGRAPH", "code_information": [{"code": "43261", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO ILLUMINATOR RFID 23G ST", "code_information": [{"code": "8065750972", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 378.38, "discounted_cash": 227.03, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO OUTLET RESTRICT W/TUBE", "code_information": [{"code": "C9785", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO RETRACT 10MM", "code_information": [{"code": "176613", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 492.81, "discounted_cash": 295.69, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO SLEEVE GASTRO W/TUBE", "code_information": [{"code": "C9784", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee 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HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO US-GUIDE HEP PORTO GRAD", "code_information": [{"code": "C9768", "type": "HCPCS"}], "standard_charges": [{"minimum": 4173.0, "maximum": 4173.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDO-FUSE  NAIL SET IMPACTOR 500035", "code_information": [{"code": "500035", "type": "CDM"}], "standard_charges": [{"gross_charge": 452.2, "discounted_cash": 271.32, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO-FUSE  SAW BLADE NARROW STRYKER 200138001", "code_information": [{"code": "200138001", "type": "CDM"}], "standard_charges": [{"gross_charge": 558.6, "discounted_cash": 335.16, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO-FUSE  SAW BLADE WIDE STRYKER 200138002", "code_information": [{"code": "200138002", "type": "CDM"}], "standard_charges": [{"gross_charge": 558.6, "discounted_cash": 335.16, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOCERVICAL CURETTAGE 57505", "code_information": [{"code": "57505", "type": "CPT"}, {"code": "1480685", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITH CC", "code_information": [{"code": "644", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7431.75, "maximum": 11720.82, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11720.82, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7431.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [{"code": "643", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11994.29, "maximum": 18797.1, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 18797.1, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11994.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "645", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5452.89, "maximum": 8832.02, "estimated_discounted_cash": 34073.55, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 8832.02, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5452.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOKNOT 0 VICRYL COATED 42 JK10G", "code_information": [{"code": "JK10G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.35, "discounted_cash": 63.21, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOLOOP 0 PDSII LIGATURE 18 EZ10G", "code_information": [{"code": "EZ10G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 288.63, "discounted_cash": 173.18, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOLUMINAL BX BILIARY TREE", "code_information": [{"code": "47543", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOLUMINAL BX URTR RNL PLVS", "code_information": [{"code": "50606", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOLUMINL IVUS OCT C 1ST", "code_information": [{"code": "92978", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOLUMINL IVUS OCT C EA", "code_information": [{"code": "92979", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOLYMPHATIC SAC OPERATION W/O SHUNT 69805", "code_information": [{"code": "69805", "type": "CPT"}, {"code": "1480686", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8536.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOLYMPHATIC SAC OPERATION;WITH SHUNT 69806", "code_information": [{"code": "69806", "type": "CPT"}, {"code": "1480687", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8536.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", 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"plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC PANCREATOSCOPY", "code_information": [{"code": "43273", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE 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8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC VEIN HARVEST", "code_information": [{"code": "33508", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY INTESTINE SMALL-DISTAL DUODENUM NOT INCL. ILEUM 44360", "code_information": [{"code": "44360", "type": "CPT"}, {"code": "1480694", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY LIGATE PERF VEINS", "code_information": [{"code": "37500", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY NASAL ETHMOIDECTOMY PARTIAL 31254", "code_information": [{"code": "31254", "type": "CPT"}, {"code": "1480695", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 10356.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY NASAL ETHMOIDECTOMY TOTAL 31255", "code_information": [{"code": "31255", "type": "CPT"}, {"code": "1480696", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 9519.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY OF URETER", "code_information": [{"code": "50951", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY SMALL BOWEL INCLUDING ILIEUM W/TRANSENDOSCOPIC PLACEMENT STENT 44379", "code_information": [{"code": "44379", "type": "CPT"}, {"code": "1480697", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 10329.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TAA REPR INCL SUBCL", "code_information": [{"code": "33880", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TAA REPR W/O SUBCL", "code_information": [{"code": "33881", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TEMPORY VESSEL OCCL", "code_information": [{"code": "61623", "type": "CPT"}], "standard_charges": [{"minimum": 3574.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 1 GRAFT", "code_information": [{"code": "34841", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee 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"CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 2 GRAFT", "code_information": [{"code": "34842", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 3 GRAFT", "code_information": [{"code": "34843", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 4 GRAFT", "code_information": [{"code": "34844", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [{"code": "266", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34236.0, "maximum": 73234.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 67947.65, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 41856.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 66628.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 34236.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 56634.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 73234.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 70016.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [{"code": "267", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34236.0, "maximum": 73234.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 53360.71, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 41856.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 66628.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 34236.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 56634.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 73234.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 56937.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVEN THER CHEM ADHES 1ST", "code_information": [{"code": "36482", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVEN THER CHEM ADHES SBSQ", "code_information": [{"code": "36483", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS LASER 1ST VEIN", "code_information": [{"code": "36478", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS LASER VEIN ADDON", "code_information": [{"code": "36479", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS MCHNCHEM 1ST VEIN", "code_information": [{"code": "36473", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS MCHNCHEM ADD-ON", "code_information": [{"code": "36474", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS RF 1ST VEIN", "code_information": [{"code": "36475", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS RF VEIN ADD-ON", "code_information": [{"code": "36476", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDPLATE INFERIOR L 3* PRODISC L     PDL-L-IP03S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PDL-L-IP03S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10920.0, "discounted_cash": 6552.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDPLATE INFERIOR L 8* PRODISC PDL-L-IP08S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PDL-L-IP08S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9945.0, "discounted_cash": 5967.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDPLATE INFERIOR M 8* PRODISC L PDL-M-IP08S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PDL-M-IP08S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9945.0, "discounted_cash": 5967.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDPLATE SUPERIOR L 3* PRODISC PDL-L-SP03S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PDL-L-SP03S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9945.0, "discounted_cash": 5967.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDPLATE VARIABLE LORDOSIS FIXATED ZERO 14-12 TBEA14120", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TBEA14120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3900.0, "discounted_cash": 2340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDURAGEN 2CM X 5CM X 1MM", "code_information": [{"code": "C9364", "type": "HCPCS"}, {"code": "89224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1258.32, "discounted_cash": 754.99, "setting": "both", "billing_class": "facility"}]}, {"description": "ENT BALLON DILATION INSPIRA AIR 16 X 40MM", "code_information": [{"code": "BC1640A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1501.2, "discounted_cash": 900.72, "setting": "both", "billing_class": "facility"}]}, {"description": "ENTAMOEB HIST DISPR AG IA", "code_information": [{"code": "87336", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 98.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 197.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 197.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 207.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 186.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 139.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 46.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 39.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTAMOEB HIST GROUP AG IA", "code_information": [{"code": "87337", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 98.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 197.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 197.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 207.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 186.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 139.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 29.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY CADAVER DONOR", "code_information": [{"code": "44132", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee 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"plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY W/O TAPER CONG", "code_information": [{"code": "44126", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIDIDYMOVASOSTOMY BILATERAL 54901", "code_information": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIDRM AUTOGRFT T/A/L ADD-ON", "code_information": [{"code": "15111", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, 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HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIDRM AUTOGRFT TRNK/ARM/LEG", "code_information": [{"code": "15110", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee 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CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPILEPSY GEN SEQ ALYS PANEL", "code_information": [{"code": "81419", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7169.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 6094.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPINEPHRINE 1:1000 0.5MG/0.5ML", "code_information": [{"code": "MED0449", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 56.31, "discounted_cash": 33.79, "setting": "both", "billing_class": "facility"}]}, {"description": "EPINEPHRINE 1:1000 1MG/ML 1ML", "code_information": [{"code": "MED0076", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 66.3, "discounted_cash": 39.78, "setting": "both", "billing_class": "facility"}]}, {"description": "EPINEPHRINE 1MG/ML 30ML", "code_information": [{"code": "MED0577", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 24.48, "discounted_cash": 14.69, "setting": "both", "billing_class": "facility"}]}, {"description": "EPINEPHRINE 30MG/30 ML", "code_information": [{"code": "MED0078", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 504.61, "discounted_cash": 302.77, "setting": "both", "billing_class": "facility"}]}, {"description": "EPINEPHRINE PF 1 MG/ML INJ 1 ML", "code_information": [{"code": "MED0823", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 56.73, "discounted_cash": 34.04, "setting": "both", "billing_class": "facility"}]}, {"description": "EPINEPHRINE-LIDOCAINE 1:100,000-1% INJ SOL 50 ML", "code_information": [{"code": "MED0388", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 18.41, "discounted_cash": 11.05, "setting": "both", "billing_class": "facility"}]}, {"description": "EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING DISTAL RADIUS AND ULNA 25455", "code_information": [{"code": "25455", "type": "CPT"}, {"code": "1480717", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING DISTAL RADIUS OR ULNA 25450", "code_information": [{"code": "25450", "type": "CPT"}, {"code": "1480718", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIPHYSEAL ARREST BY EPIPHYSIODESIS OR STAPLING FEMUR 27185", "code_information": [{"code": "27185", "type": "CPT"}, {"code": "1480719", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPISIOTOMY OR VAGINAL REPAIR", "code_information": [{"code": "59300", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPISTAXIS WITH MCC", "code_information": [{"code": "150", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9743.85, "maximum": 15676.91, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 15676.91, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9743.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPISTAXIS WITHOUT MCC", "code_information": [{"code": "151", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5165.89, "maximum": 8597.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 8597.24, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5165.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPOETIN ALFA, 100 UNITS ESRD", "code_information": [{"code": "Q4081", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ERBE NESSY MONITORING SPLIT PAD 168 CM 20193-070", "code_information": [{"code": "20193-070", "type": "CDM"}], "standard_charges": [{"gross_charge": 18.17, "discounted_cash": 10.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ERBE REUSABLE PAD CONNECTING CABLE  20194-085", "code_information": [{"code": "20194-085", "type": "CDM"}], "standard_charges": [{"gross_charge": 470.84, "discounted_cash": 282.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ERCP DUCT STENT PLACEMENT", "code_information": [{"code": "43274", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP EA DUCT/AMPULLA DILATE", "code_information": [{"code": "43277", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP LESION ABLATE W/DILATE", "code_information": [{"code": "43278", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP LITHOTRIPSY CALCULI", "code_information": [{"code": "43265", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP REMOVE DUCT CALCULI", "code_information": [{"code": "43264", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP REMOVE FORGN BODY DUCT", "code_information": [{"code": "43275", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP REMOVE FORGN BODY&ENDO", "code_information": [{"code": "C7560", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP RMV CALC PANCREATOSCOPY", "code_information": [{"code": "C7544", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP SPHINCTER PRESSURE MEAS", "code_information": [{"code": "43263", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP STENT EXCHANGE W/DILATE", "code_information": [{"code": "43276", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP W/ PANCREATOSCOPY", "code_information": [{"code": "C7541", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP W/BX & PANCREATOSCOPY", "code_information": [{"code": "C7542", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP W/OPTICAL ENDOMICROSCPY", "code_information": [{"code": "397T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP W/OTOMY, PANCREATOSCOPY", "code_information": [{"code": "C7543", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP W/SPECIMEN COLLECTION", "code_information": [{"code": "43260", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERYTHROMYCIN OPHTHALMIC 0.5% OINTMENT 3.5 GM", "code_information": [{"code": "MED0077", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 57.12, "discounted_cash": 34.27, "setting": "both", "billing_class": "facility"}]}, {"description": "ERYTHROMYCIN OPHTHALMIC OINTMENT 0.5% 1GM", "code_information": [{"code": "MED0079", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 31.29, "discounted_cash": 18.77, "setting": "both", "billing_class": "facility"}]}, {"description": "ES2 RING 48281202", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48281202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1747.77, "discounted_cash": 1048.66, "setting": "both", "billing_class": "facility"}]}, {"description": "ESCHAROTOMY ADDL INCISION", "code_information": [{"code": "16036", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESD ENDOSCOPY OR COLONOSCOPY", "code_information": [{"code": "C9779", "type": "HCPCS"}], "standard_charges": [{"minimum": 3866.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESG PLASMA OVAL BUTTON", "code_information": [{"code": "WA22766S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1064.0, "discounted_cash": 638.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ESG PLASMALOOP 24FR LARGE 30 WA22707S", "code_information": [{"code": "WA22707S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 835.24, "discounted_cash": 501.14, "setting": "both", "billing_class": "facility"}]}, {"description": "ESOPH BALLOON DISTENSION TST", "code_information": [{"code": "91040", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH ENDOSCOPY DILATION", "code_information": [{"code": "43226", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH FUNDOPLASTY LAP", "code_information": [{"code": "43327", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH FUNDOPLASTY THOR", "code_information": [{"code": "43328", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH IMPED FUNCT TEST > 1HR", "code_information": [{"code": "91038", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH IMPED FUNCTION TEST", "code_information": [{"code": "91037", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH LENGTHENING", "code_information": [{"code": "43338", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH OPTICAL ENDOMICROSCOPY", "code_information": [{"code": "43206", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH SCOPE W/SCLEROSIS INJ", "code_information": [{"code": "43204", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH SCOPE W/SUBMUCOUS INJ", "code_information": [{"code": "43201", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAG MUC INTEG W/ESO EGD", "code_information": [{"code": "C9777", "type": "HCPCS"}], "standard_charges": [{"minimum": 3866.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL MOTILITY STUDY", "code_information": [{"code": "78258", "type": "CPT"}], "standard_charges": [{"minimum": 452.25, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 452.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 908.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 908.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 956.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 860.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 640.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL RECORDING", "code_information": [{"code": "93615", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8928.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL RECORDING", "code_information": [{"code": "93616", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8928.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL STETHOSCOPE 18FR. DYNJAES40018", "code_information": [{"code": "DYNJAES40018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.37, "discounted_cash": 8.02, "setting": "both", "billing_class": "facility"}]}, {"description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [{"code": "391", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8965.81, "maximum": 14568.8, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 14568.8, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8965.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [{"code": "392", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5544.64, "maximum": 8850.16, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 8850.16, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5544.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOGASTRIC FUNDOPLASTY W/FUNDIC PATCH 43325", "code_information": [{"code": "43325", "type": "CPT"}, {"code": "1480720", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOGASTRODUODENOSCOPY BALLOON DILATATION 43249", "code_information": [{"code": "43249", "type": "CPT"}, {"code": "1480722", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOGASTRODUODENOSCOPY GASTRIC OUTLET DILATATION 43245", "code_information": [{"code": "43245", "type": "CPT"}, {"code": "1480723", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOGASTRODUODENOSCOPY W/BIOPSY 43239", "code_information": [{"code": "43239", "type": "CPT"}, {"code": "1480724", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOGASTRODUODENOSCOPY W/GUIDE WIRE DILATATION 43248", "code_information": [{"code": "43248", "type": "CPT"}, {"code": "1480725", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOGASTRODUODENOSCOPY; FLEXIBLE DIAGNOSTIC 43235", "code_information": [{"code": "43235", "type": "CPT"}, {"code": "1480721", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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{"description": "ESOPHAGOMYOTOMY ABDOMINAL", "code_information": [{"code": "43330", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOMYOTOMY THORACIC", "code_information": [{"code": "43331", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": 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"plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOPLASTY CONGENITAL", "code_information": [{"code": "43313", "type": "CPT"}], 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSC FLEX TRNSN BIOPSY", "code_information": [{"code": "43198", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP MUCOSAL RESECT", "code_information": [{"code": "43211", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP STENT PLACEMENT", "code_information": [{"code": "43212", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP ULTRASOUND EXAM", "code_information": [{"code": "43231", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY BALLOON <30MM", "code_information": [{"code": "43220", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY CONTROL BLEED", "code_information": [{"code": "43227", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEX DX BRUSH", "code_information": [{"code": "43197", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEX REMOVE FB", "code_information": [{"code": "43215", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY LESION ABLATE", "code_information": [{"code": "43229", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY LESION REMOVAL", "code_information": [{"code": "43216", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID BALLOON", "code_information": [{"code": "43195", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID OR FLEX DIAG W/ OR W/O BRUSH/WASH 43200", "code_information": [{"code": "43200", "type": "CPT"}, {"code": "1601525", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 9519.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID OR FLEXIBLE W/BX SINGLE OR MULTI 43202", "code_information": [{"code": "43202", "type": "CPT"}, {"code": "1587131", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID TRANSORAL DIAG W/COL. OF SPECIMEN BY BRUSH OR WASH 43191", "code_information": [{"code": "43191", "type": "CPT"}, {"code": "18353986", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 10356.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID TRANSORAL W/BIOPSY SINGLE OR MULTIPLE 43193", "code_information": [{"code": "43193", "type": "CPT"}, {"code": "18353993", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1659.0, "maximum": 10356.0, "gross_charge": 5557.0, "discounted_cash": 3334.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 3056.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID TRNSO", "code_information": [{"code": "43180", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY SNARE LES REMV", "code_information": [{"code": "43217", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY W/US NEEDLE BX", "code_information": [{"code": "43232", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP GUIDE WIRE 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CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP RIG TRNSO INJECT", "code_information": [{"code": "43192", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP RIG TRNSO REM FB", "code_information": [{"code": "43194", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 9519.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGUS ENDOSCOPY/LIGATION", "code_information": [{"code": "43205", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 1 VISIT P MO 20+", "code_information": [{"code": "90962", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 1 VISIT P MO <2YRS", "code_information": [{"code": "90953", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 1 VST P MO 12-19", "code_information": [{"code": "90959", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 2-3 VSTS P MO <2YR", "code_information": [{"code": "90952", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 4 VISITS P MO <2YR", "code_information": [{"code": "90951", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 4 VSTS P MO 2-11", "code_information": [{"code": "90954", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 1 VISIT P MO 2-11", "code_information": [{"code": "90956", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 2-3 VSTS P MO 12-19", "code_information": [{"code": "90958", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 2-3 VSTS P MO 2-11", "code_information": [{"code": "90955", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 2-3 VSTS P MO 20+", "code_information": [{"code": "90961", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 4 VISITS P MO 20+", "code_information": [{"code": "90960", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 4 VSTS P MO 12-19", "code_information": [{"code": "90957", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT 12-19", "code_information": [{"code": "90969", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT 2-11", "code_information": [{"code": "90968", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT 20+", "code_information": [{"code": "90970", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT <2", "code_information": [{"code": "90967", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH ACCESS TO AORTA", "code_information": [{"code": "36160", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH ACCESS TO ARTERY", "code_information": [{"code": "36100", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62180", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62200", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62223", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14483.0, "setting": 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESW INTEG WND HLG 1ST WND", "code_information": [{"code": "512T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 4173.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESW INTEG WND HLG EA ADDL", "code_information": [{"code": "513T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 4173.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", 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"standard_charges": [{"minimum": 8982.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ET TUBE 4.0 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-AO NDGFT", "code_information": [{"code": "34701", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": 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SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-AO NDGFT RPT", "code_information": [{"code": "34702", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-BIILIAC RPT", "code_information": [{"code": "34706", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-ILIAC NDGFT", "code_information": [{"code": "34717", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-UNILAC NDGFT", "code_information": [{"code": "34703", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-UNILAC NDGFT RPT", "code_information": [{"code": "34704", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR ILIO-ILIAC NDGFT", "code_information": [{"code": "34707", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR ILIO-ILIAC RPT", "code_information": [{"code": "34708", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR N/A A-ILIAC NDGFT", "code_information": [{"code": "34718", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": 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"plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC CH WAL TUM W/O LYMPHADEC", "code_information": [{"code": "21602", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC CHEST WALL TUMOR W/RIBS", "code_information": [{"code": "21601", "type": "CPT"}], "standard_charges": [{"minimum": 3866.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC LESION SPERMATIC CORD SEPARATE PROC 55520", "code_information": [{"code": "55520", "type": "CPT"}, {"code": "1643988", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee 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TRUNK/ARM/LEG 0.5CM OR LESS 11600", "code_information": [{"code": "11600", "type": "CPT"}, {"code": "1700090", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC NEUROMA W/ IMPLNT NV END", "code_information": [{"code": "C7551", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC PAROTID TUMOR OR GLAND LATERAL LOBE TOTAL W/DISSEC. 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC RECT TUM TRANSANAL FULL", "code_information": [{"code": "45172", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE 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5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC SKN H/P/P/U COMPLEX", "code_information": [{"code": "11471", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXC.OF CHALAZION W/GEN.ANESTHESIA REQUIRING HOSPITALIZATION SINGLE OR MULTI 67808", "code_information": [{"code": "67808", "type": "CPT"}, {"code": "1480732", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCAVATE TOOTH NON-RESTORABL", "code_information": [{"code": "D2989", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 2566.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCH BIL CATH W/ RMV CALCULI", "code_information": [{"code": "C7545", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCH NEPH CATH W/ DIL STRIC", "code_information": [{"code": "C7548", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCHANGE BILIARY DRG CATH", "code_information": [{"code": "47536", "type": "CPT"}], "standard_charges": [{"minimum": 3574.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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"plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCHANGE DRAINAGE CATHETER", "code_information": [{"code": "49423", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCHANGE NEPHROSTOMY CATH", "code_information": [{"code": "50435", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCHANGE OF INTRAOCULAR LENS 66986", "code_information": [{"code": "66986", "type": "CPT"}, {"code": "1480733", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7760.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 6596.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCHANGER HEAT MOISTURE 15MM X 22MM NON STRL TREATED OPEN CELL FOAM MEDIA WITHOU", "code_information": [{"code": "2840", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.42, "discounted_cash": 3.25, "setting": "both", "billing_class": "facility"}]}, {"description": "EXCHANGER TUBE 6.0MM TO 8.5MM TRACHEAL", "code_information": [{"code": "524004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 196.39, "discounted_cash": 117.83, "setting": "both", "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS 250-500", "code_information": [{"code": "96921", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS<250SQCM", "code_information": [{"code": "96920", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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"plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE ANAL EXT TAG/PAPILLA", "code_information": [{"code": "46220", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE BREAST DUCT FISTULA", "code_information": [{"code": "19112", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE EPIPHYSEAL BAR", "code_information": [{"code": "20150", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESS SKIN ARM/HAND", "code_information": [{"code": "15837", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE ILEOANAL RESERVIOR", "code_information": [{"code": "45136", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE INTESTINE LESION(S)", "code_information": [{"code": "44110", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION LMBR", "code_information": [{"code": "63272", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE LWR JAW CYST W/REPAIR", "code_information": [{"code": "21047", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE MAX/ZYGOMA MAL TUMOR", "code_information": [{"code": "21034", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42425", "type": "CPT"}], "standard_charges": [{"minimum": 3869.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42426", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE SUBLINGUAL GLAND", "code_information": [{"code": "42450", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION ADDL BREAST LESION", "code_information": [{"code": "19126", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GANGLION WRIST PRIMARY 25111", "code_information": [{"code": "25111", "type": "CPT"}, {"code": "1480769", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT ABDOMEN", "code_information": [{"code": "35907", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT EXTREMITY", "code_information": [{"code": "35903", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT NECK", "code_information": [{"code": "35901", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT THORAX", "code_information": [{"code": "35905", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GUM EACH QUADRANT", "code_information": [{"code": "41820", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GYNECOMASTIA 19300", "code_information": [{"code": "19300", "type": "CPT"}, {"code": "1480770", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION HAND/FINGER TENDON", "code_information": [{"code": "26415", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BOWEL LESION(S)", "code_information": [{"code": "44111", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM FLAP", "code_information": [{"code": "41821", 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF HYDROCELE;UNILATERAL 55040", "code_information": [{"code": "55040", "type": "CPT"}, {"code": "1480834", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF PENILE PLAQUE 54110", "code_information": [{"code": "54110", "type": "CPT"}, {"code": "42873626", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.7, "maximum": 8427.0, "gross_charge": 1534.0, "discounted_cash": 920.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL PROLAPSE", "code_information": [{"code": "45135", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKIN AND SQ TISSUE FOR HIDRANDENITIS AXILLARY W/COMPLEX REPAIR 11450", "code_information": [{"code": "11450", "type": "CPT"}, {"code": "2034639", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 886.05, "maximum": 8427.0, "gross_charge": 1611.0, "discounted_cash": 966.6, "setting": "both", "payers_information": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKIN/TISSUE HIDRADENITIS COMPLEX 11451", "code_information": [{"code": "11451", "type": "CPT"}, {"code": "2401580", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCL LAA OPEN ANY METHOD", "code_information": [{"code": "33267", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXENTERATION OF ORBITREMOVAL OF ORBITAL CONTENTS AND BONE 65112", "code_information": [{"code": "65112", "type": "CPT"}, {"code": "1480911", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8536.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": 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"standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXENTERATION OF ORBITREMOVAL OF ORBITAL CONTENTS AND MUSCLE 65114", "code_information": [{"code": "65114", "type": "CPT"}, {"code": "1480912", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8536.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": 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{"description": "EXP 5.5 SS 6.5 WIDE BLADE HK 188152046", "code_information": [{"code": "188152046", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXP 5.5 SS 8.0 ANG BLADE HK 188152028", "code_information": [{"code": "188152028", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXP 5.5 SS 8.0 NRW BLADE HK 188152038", "code_information": [{"code": "188152038", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXP 5.5 SS 8.0 WIDE BLADE HK 188152048", "code_information": [{"code": "188152048", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXP 635 TI SHRT BDY 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[{"gross_charge": 598.5, "discounted_cash": 359.1, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPANDER TISSUE 250ML 10.1CM X 10.7CM X 5.6CM STYLE 6300 TALL HEIGHT CPX3", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "354-7311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3455.4, "discounted_cash": 2073.24, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPANDER TISSUE 300CC 11 CM X 10 CM 5 CM BREAST STYLE 133MX BIOCELL TEXTURED MOD", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "133MX-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3232.66, "discounted_cash": 1939.6, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPANDER TISSUE 350ML 11.3CM X 11.8CM X 6CM TALL HEIGHT CPX3", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "354-7312", "type": "CDM"}, {"code": "278", "type": 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{"description": "EXPAREL 1.3% (BUPIVACAINE LIPOSOME INJECTABLE SUSPENSION) 266MG/20ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0666", "type": "HCPCS"}, {"code": "MED0264", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 784.5, "discounted_cash": 470.7, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPEDIUM SS PEDICLE HOOK 188152002", "code_information": [{"code": "188152002", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPEDIUM SS PEDICLE HOOK 189652100", "code_information": [{"code": "189652100", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPEDIUM TI PEDICLE HOOK 179752002", "code_information": [{"code": "179752002", "type": "CDM"}], "standard_charges": 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION FOR UNDESCENDED TESTIS 54550", "code_information": [{"code": "54550", "type": "CPT"}, {"code": "1480917", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION FOR UNDESCENDED TESTIS WITH ABDOMINAL EXPLORATION 54560", "code_information": [{"code": "54560", "type": "CPT"}, {"code": "1480918", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "39010", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF 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"plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY 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"UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION RETROPERITONEAL AREA 49010", "code_information": [{"code": "49010", "type": "CPT"}, {"code": "1480922", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, 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[{"code": "20100", "type": "CPT"}, {"code": "1480923", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 18989.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION WOUND EXTREMITY 20103", "code_information": [{"code": "20103", "type": "CPT"}, {"code": "1480925", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, 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2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION/REPAIR OF RECTUM", "code_information": [{"code": "45563", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE EPIDIDYMIS", "code_information": [{"code": "54865", 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE LIMB VESSELS", "code_information": [{"code": "35860", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 9519.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE NECK VESSELS", "code_information": [{"code": "35800", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE ORBIT/REMOVE LESION", "code_information": [{"code": "61333", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE PARATHYROID GLANDS", "code_information": [{"code": "60505", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE TREAT SHOULDER JOINT", "code_information": [{"code": "23107", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/REPAIR CHEST", "code_information": [{"code": "32110", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D REC SCAN A/R", "code_information": [{"code": "93241", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D RECORDING", "code_information": [{"code": "93242", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D REV&INTERPJ", "code_information": [{"code": "93244", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D SCAN A/R", "code_information": [{"code": "93243", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D REC SCAN A/R", "code_information": [{"code": "93245", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D REV&INTERPJ", "code_information": [{"code": "93248", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D SCAN A/R", "code_information": [{"code": "93247", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT. TAB ANGLED BLADE HOOK 179752220", "code_information": [{"code": "179752220", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXT. TAB NARROW BLADE HOOK 179752230", "code_information": [{"code": "179752230", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXT. TAB PEDICLE HOOK 179752200", "code_information": [{"code": "179752200", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXT. TAB REDUCED DISTANCE HOOK 179752210", "code_information": [{"code": "179752210", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXT. TAB WIDE BLADE HOOK 179752240", "code_information": [{"code": "179752240", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENDED BODY HOOK 179752050", "code_information": [{"code": "179752050", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENDED BODY HOOK 7722-0509", "code_information": [{"code": "7722-0509", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENDED CULTURE OF OOCYTES", "code_information": [{"code": "89272", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 319.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 642.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 642.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 676.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 608.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 453.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2273.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1932.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENDED LAMINA HOOK LARGE 25-21-1009", "code_information": [{"code": "25-21-1009", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENDED LAMINA HOOK NARROW   6MM 7241119", "code_information": [{"code": "7241119", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENDED LAMINA HOOK NARROW   8MM 7241120", "code_information": [{"code": "7241120", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENDED LAMINA HOOK-LG 10-21-1009", "code_information": [{"code": "10-21-1009", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENDED VISUAL FIELD XM", "code_information": [{"code": "92083", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENDER 6550017 5.5/6.0 SV TAB EXTENDER 6550017", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6550017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 984.0, "discounted_cash": 590.4, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENDER BTN SUT TIGHTROPE IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1589RT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 324.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENDER TUBEINSTR", "code_information": [{"code": "TE", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 390.73, "discounted_cash": 234.44, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENSION ELECTRODE 34.3 CM BOVIE TIP STRAIGHT REUSE", "code_information": [{"code": "E1504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 242.88, "discounted_cash": 145.73, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENSION LEAD 10 CM PACING DUAL 4 CHANNEL", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "3341", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2145.13, "discounted_cash": 1287.08, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENSION STEM 15MM X 75MM 30MM STRAIGHT NEXGEN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "-5988-012-15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2733.14, "discounted_cash": 1639.88, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [{"code": "927", "type": "MS-DRG"}], "standard_charges": [{"minimum": 134942.23, "maximum": 134942.23, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 38.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 134942.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [{"code": "933", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20994.6, "maximum": 20994.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 38.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 20994.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HAND SURGERY", "code_information": [{"code": "26250", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE JAW SURGERY", "code_information": [{"code": "21045", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE MASTOID SURGERY", "code_information": [{"code": "69530", "type": "CPT"}], "standard_charges": [{"minimum": 3869.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [{"code": "982", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18004.29, "maximum": 27768.62, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 27768.62, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 18004.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [{"code": "981", "type": "MS-DRG"}], "standard_charges": [{"minimum": 32079.47, "maximum": 53918.73, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 53918.73, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 32079.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "983", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11517.19, "maximum": 18920.72, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 18920.72, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11517.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55812", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55815", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55840", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee 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MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55842", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55845", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55862", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55865", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE STERNUM SURGERY", "code_information": [{"code": "21630", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42842", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRA SMALL ANGLED HANDLE 05-707", "code_information": [{"code": "5-707", "type": "CDM"}], "standard_charges": [{"gross_charge": 1503.36, "discounted_cash": 902.02, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRA SMALL CANNULATED HANDLE 05-703", "code_information": [{"code": "5-703", "type": "CDM"}], "standard_charges": [{"gross_charge": 1503.36, "discounted_cash": 902.02, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACAPSULAR CATARACT REM. W/INSERT INTRAOCULAR LENS COMPLEX MAN. OR MECH. TECH. 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7982.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACORPOREAL SHOCK WAVE THERAPY INVOLVING PLANTAR FASCIA 28890", "code_information": [{"code": "28890", "type": "CPT"}, {"code": "1480929", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "gross_charge": 7110.0, "discounted_cash": 4266.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 3910.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [{"code": "38", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8412.0, "maximum": 25893.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 18275.36, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 10285.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 16372.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8412.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 13916.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 25893.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12270.28, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 12014.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11413.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10813.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS 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"standard_charge_dollar": 25893.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 23559.93, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 12014.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11413.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10813.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 10212.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "39", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8311.82, "maximum": 17653.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 12909.46, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 10285.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 16372.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8412.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 13916.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 17653.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8311.82, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 12014.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11413.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10813.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 10212.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL UNI/LTD STUDY", "code_information": [{"code": "93882", "type": "CPT"}], "standard_charges": [{"minimum": 397.64, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACTION POUCHES / RETRIEVAL NETS EnTrap Polyp Retrieval Net 133-5543 30  230 2.8", "code_information": [{"code": "NT54511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 171.2, "discounted_cash": 102.72, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTION POUCHES / RETRIEVAL NETS EnTrap Polyp Retrieval Net 1356057 30  230 2.8", "code_information": [{"code": "54515", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 172.5, "discounted_cash": 103.5, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR KATZ FOREIGN BODY REMOVAL OTO-RHINO", "code_information": [{"code": "FB5000", "type": "CDM"}], "standard_charges": [{"gross_charge": 220.05, "discounted_cash": 132.03, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR STAPLE PSX PROXIMATE PSX", "code_information": [{"code": "PSX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.4, "discounted_cash": 9.24, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR STONE 115 CM X 2.2FR 1 CM BASKET TIPLESS N CIRCLE", "code_information": 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"setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR STONE 6 WIRE .6MM", "code_information": [{"code": "11575L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1253.25, "discounted_cash": 751.95, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR STONE FRENCH 2.2 115 CM TIPLESS NITINOL MEMORY WIRE NCIRCLE", "code_information": [{"code": "G18777", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 515.85, "discounted_cash": 309.51, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR STONE NCIRCLE TIPLESS 1.5FR X 115CM DISP", "code_information": [{"code": "G46206", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 638.4, "discounted_cash": 383.04, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR STONE PERC NCIRCLE NITINOL TIPLESS 10FR", "code_information": [{"code": "G32862", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 409.54, "discounted_cash": 245.72, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR STONE TIPLESS G46027", "code_information": [{"code": "G46027", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 981.27, "discounted_cash": 588.76, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [{"code": "115", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9997.81, "maximum": 17364.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 17364.6, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9997.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRAORAL I&D ABSCESS OF CYST OR HEMATOMA; SUBMANDIBULAR 41017", "code_information": [{"code": "41017", "type": "CPT"}, {"code": "44696609", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 819.5, "maximum": 8427.0, "gross_charge": 1490.0, "discounted_cash": 894.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 819.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRAORAL I&D OF ABSCESS/CYST/HEMATOMA OF FLOOR OF MOUTH SUBLINGUAL 41015", "code_information": [{"code": "41015", "type": "CPT"}, {"code": "33089746", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRAORAL INCISION AND DRAINAGE OF ABSCESS; CYST/HEMATOMA OF FLOOR OF MOUTH 41016", "code_information": [{"code": "41016", "type": "CPT"}, {"code": "44568207", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.7, "maximum": 8427.0, "gross_charge": 1534.0, "discounted_cash": 920.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [{"code": "790", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2945.0, "maximum": 40269.44, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2945.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3182.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 4534.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4773.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 4296.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 3198.0, "methodology": "per diem"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 40269.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3142.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4625.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4163.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EXTREMITY SHEET TIBURON", "code_information": [{"code": "29415", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.69, "discounted_cash": 19.01, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRNL COUNTERPULSE, PER TX", "code_information": [{"code": "G0166", "type": "HCPCS"}], "standard_charges": [{"minimum": 3004.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTSET CATH7.9\" 20CMSTRAIGHTCLEARLIN 2N8374", "code_information": [{"code": "2N8374", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 11.19, "discounted_cash": 6.71, "setting": "both", "billing_class": "facility"}]}, {"description": "EYE ALLERGY TESTS", "code_information": [{"code": "95060", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE MVMT ALYS W/O CALBRJ I&R", "code_information": [{"code": "615T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EYE PACK STANDARD ALCON SURGICAL AS2277-26", "code_information": [{"code": "AS2277-26", "type": "CDM"}], "standard_charges": [{"gross_charge": 559.21, "discounted_cash": 335.53, "setting": "both", "billing_class": "facility"}]}, {"description": "EYE PADS C-EYP22S", "code_information": [{"code": "C-EYP22S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.3, "discounted_cash": 0.18, "setting": "both", "billing_class": "facility"}]}, {"description": "EYE PHOTODYNAMIC THER ADD-ON", "code_information": [{"code": "67225", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": 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SPHERE 14MM SILICONE  S6.1014", "code_information": [{"code": "S6.1014", "type": "CDM"}], "standard_charges": [{"gross_charge": 315.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EYE SURGERY FOLLOW-UP ADD-ON", "code_information": [{"code": "67331", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE SUTURE DURING SURGERY", "code_information": [{"code": "67335", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, 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DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM CANAL BRUSH NW 12.5MM 110033", "code_information": [{"code": "110033", "type": "CDM"}], "standard_charges": [{"gross_charge": 390.29, "discounted_cash": 234.17, "setting": "both", "billing_class": "facility"}]}, {"description": "FEM CANAL BRUSH STD 19MM 110003", "code_information": [{"code": "110003", "type": "CDM"}], "standard_charges": [{"gross_charge": 357.11, "discounted_cash": 214.27, "setting": "both", "billing_class": "facility"}]}, {"description": "FEM COMP SZ 6 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71421176", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "FEM/POP REVASC W/ARTHR & US", "code_information": [{"code": "C7534", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM/POP REVASC W/STENT & US", "code_information": [{"code": "C7535", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVAS W/ATHER", "code_information": [{"code": "37225", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVAS W/TLA", "code_information": [{"code": "37224", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVASC STNT & ATHER", "code_information": [{"code": "37227", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 37880.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 21883.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 37880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34092.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVASC W/STENT", "code_information": [{"code": "37226", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [{"code": "748", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9497.96, "maximum": 15451.21, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 15451.21, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9497.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEMORAL AS COLUMBUS CR COMP.CEMENTED F5L NN005Z", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "NN005Z", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10910.86, "discounted_cash": 6546.52, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL ATTUNE KNEE SYSTEM REVISION POSTERIOR FEMORAL AUGMENT 8MM CEMENTED SIZE 4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1549-04-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 990.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL CANAL AWL 4200-240-0", "code_information": [{"code": "4200-240-0", "type": "CDM"}], "standard_charges": [{"gross_charge": 584.46, "discounted_cash": 350.68, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL COMPONENT COCRMO CEMENTED RT SZ4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6515.09.140", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6760.0, "discounted_cash": 4056.0, "setting": "both", "billing_class": "facility"}]}, {"description": 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"billing_class": "facility"}]}, {"description": "FEMUR SZ 6 POROUS RIGHT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "236-02-106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12383.39, "discounted_cash": 7430.03, "setting": "both", "billing_class": "facility"}]}, {"description": "FENTANYL 0.05MG/ML 2ML", "code_information": [{"code": "MED0389", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 22.51, "discounted_cash": 13.51, "setting": "both", "billing_class": "facility"}]}, {"description": "FENTANYL 250MCG/5ML AMP", "code_information": [{"code": "MED0461", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.32, "discounted_cash": 4.39, "setting": "both", "billing_class": "facility"}]}, {"description": "FERN TEST", "code_information": [{"code": "Q0114", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.24, "maximum": 123.82, "setting": 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"plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 160.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL BIOPHYS PROFILE W/NST", "code_information": [{"code": "76818", "type": "CPT"}], "standard_charges": [{"minimum": 348.49, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and 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"standard_charge_dollar": 1874.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1973.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1776.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1322.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2222.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1889.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL CHRMOML MICRODELTJ", "code_information": [{"code": "81422", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2222.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1889.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL CONTRACT STRESS TEST", "code_information": [{"code": "59020", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 259.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 520.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 520.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 547.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 492.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 366.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL CORD PUNCTURE PRENATAL", "code_information": [{"code": "59012", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL FLUID DRAINAGE W/US", "code_information": [{"code": "59074", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL MONITOR W/REPORT", "code_information": [{"code": "59050", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL MONITOR/INTERPRET ONLY", "code_information": [{"code": "59051", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL NON-STRESS TEST", "code_information": [{"code": "59025", "type": "CPT"}], "standard_charges": [{"minimum": 228.49, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 228.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 458.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 458.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 483.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 434.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 323.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL SCALP BLOOD SAMPLE", "code_information": [{"code": "59030", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL SHUNT PLACEMENT W/US", "code_information": [{"code": "59076", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", 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"standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 413.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 829.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 829.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 873.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 786.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 585.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 167.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 141.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FMR1 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81244", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 302.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 606.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 606.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 638.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 574.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 428.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 131.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 111.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FMRI BRAIN BY PHYS/PSYCH", "code_information": [{"code": "70555", "type": "CPT"}], "standard_charges": [{"minimum": 1310.13, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1310.13, "methodology": "fee 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for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 955.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1918.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1918.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2019.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1817.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1353.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/CT GDN 1ST LES", "code_information": [{"code": "10009", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/CT GDN EA ADDL", "code_information": [{"code": "10010", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/FLUOR GDN 1ST LES", "code_information": [{"code": "10007", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/FLUOR GDN EA ADDL", "code_information": [{"code": "10008", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/MR GDN 1ST LES", "code_information": [{"code": "10011", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/MR GDN EA ADDL", "code_information": [{"code": "10012", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/O IMG GDN EA ADDL", "code_information": [{"code": "10004", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/US GDN 1ST LES", "code_information": [{"code": "10005", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/US GDN EA ADDL", "code_information": [{"code": "10006", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOAM ROLL CHEST POSITIONER FP-CHEST", "code_information": [{"code": "FP-CHEST", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 15.58, "discounted_cash": 9.35, "setting": "both", "billing_class": "facility"}]}, {"description": "FOAM STABILITY FETAL LUNG", "code_information": [{"code": "83662", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 154.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 311.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 311.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 327.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 294.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 219.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 55.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 47.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOAM ULNAR NERVE POSITIONER", "code_information": [{"code": "FP-UN1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.6, "discounted_cash": 3.96, "setting": "both", "billing_class": "facility"}]}, {"description": "FOCUSED LATERAL RETRACTOR ILLUMINATOR 95-6778", "code_information": [{"code": "95-6778", "type": "CDM"}], "standard_charges": [{"gross_charge": 494.76, "discounted_cash": 296.86, "setting": "both", "billing_class": "facility"}]}, {"description": "FOLEY TRAY 18FR LUBRI-SIL LF 907318", "code_information": [{"code": "907318", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.33, "discounted_cash": 22.4, "setting": "both", "billing_class": "facility"}]}, {"description": "FOLLOW-UP ANGIOGRAPHY", "code_information": [{"code": "75898", "type": "CPT"}], "standard_charges": [{"minimum": 366.1, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 366.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 735.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 735.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 773.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 696.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 518.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLLOWER 10-24 STRAIGHT SET 021100", "code_information": [{"code": "21100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.31, "discounted_cash": 31.39, "setting": "both", "billing_class": "facility"}]}, {"description": "FOOD THICKENER ORAL", "code_information": [{"code": "B4100", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FOOT PROCEDURES WITH CC", "code_information": [{"code": "504", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3870.0, "maximum": 19905.21, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 19905.21, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 4732.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7533.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 3870.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 6403.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 9144.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12694.53, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 4699.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOOT PROCEDURES WITH MCC", "code_information": [{"code": "503", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3870.0, "maximum": 30017.74, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 30017.74, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 4732.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7533.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 3870.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 6403.0, "methodology": "case 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"code_information": [{"code": "389.184", "type": "CDM"}], "standard_charges": [{"gross_charge": 3065.04, "discounted_cash": 1839.02, "setting": "both", "billing_class": "facility"}]}, {"description": "FORKED IMPACTOR-ANGLE SUPERIOR 389.185", "code_information": [{"code": "389.185", "type": "CDM"}], "standard_charges": [{"gross_charge": 3065.04, "discounted_cash": 1839.02, "setting": "both", "billing_class": "facility"}]}, {"description": "FORTIFY 12MM CORE  HEIGHT 19-25MM 151.051", "code_information": [{"code": "C1062", "type": "HCPCS"}, {"code": "151.051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 7149.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", 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"standard_charges": [{"gross_charge": 5720.0, "discounted_cash": 3432.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FOSCARNET 2.4MG/0.1ML OPHTHALMIC", "code_information": [{"code": "MED0679", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1090.96, "discounted_cash": 654.58, "setting": "both", "billing_class": "facility"}]}, {"description": "FOSPHENYTOIN INJ PE", "code_information": [{"code": "Q2009", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FRACTIONATION KETOSTEROIDS", "code_information": [{"code": "83593", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", 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"standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 285.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 574.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 574.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, 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"SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 4699.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF FEMUR WITH MCC", "code_information": [{"code": "533", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4699.0, "maximum": 17295.42, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 17295.42, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11233.87, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 4699.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [{"code": "534", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4699.0, "maximum": 9232.39, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9232.39, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5692.17, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE JEJUNUM FLAP MICROVASC", "code_information": [{"code": "43496", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE MYO/SKIN FLAP MICROVASC", "code_information": [{"code": "15756", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": 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"methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRENULOTOMY OF PENIS", "code_information": [{"code": "54164", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 132.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 98.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 35.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}], "billing_class": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 82.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 165.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 165.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 174.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 156.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 116.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 38.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 32.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR N/E/E/L EACH ADDL", "code_information": [{"code": "15261", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, 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"standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR TRNK EACH ADDL", "code_information": [{"code": "15201", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL ANEUPLOIDY STR ALYS DNA", "code_information": [{"code": "252U", "type": "CPT"}], "standard_charges": [{"minimum": 1889.15, "maximum": 2222.68, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2222.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1889.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL ANEUPLOIDY TRSMY DNA SEQ", "code_information": [{"code": "327U", "type": "CPT"}], "standard_charges": [{"minimum": 1978.64, "maximum": 2327.96, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2327.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1978.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR 3 PROTEINS", "code_information": [{"code": "81509", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 4355.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3701.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR FIVE ANAL", "code_information": [{"code": "81512", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 203.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 173.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR FOUR ANAL", "code_information": [{"code": "81511", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 75.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 162.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 138.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR TWO PROTEINS", "code_information": [{"code": "81508", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 159.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 135.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL FIELD ERG W/I&R", "code_information": [{"code": "92273", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL MOUTH X-RAY OF TEETH", "code_information": [{"code": "70320", "type": "CPT"}], "standard_charges": [{"minimum": 145.15, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 145.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 291.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 291.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 306.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 276.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 205.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1022.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 868.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [{"code": "793", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2945.0, "maximum": 28250.93, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2945.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3182.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 4534.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4773.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 4296.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 3198.0, "methodology": "per diem"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 28250.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3142.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4625.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4163.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC", "code_information": [{"code": "928", "type": "MS-DRG"}], "standard_charges": [{"minimum": 43126.9, "maximum": 43126.9, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 38.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 43126.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC", "code_information": [{"code": "929", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21815.95, "maximum": 21815.95, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 38.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 21815.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [{"code": "934", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13457.89, "maximum": 13457.89, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 38.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13457.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS GRAFT 20SQ CM OR LESS 15220", "code_information": [{"code": "15220", "type": "CPT"}, {"code": "1480963", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS GRAFT FREE INC. DIRECT CLOSURE OF DONOR SITE SCALP/ARM/LEG EA. ADD. 20SQ CM 15221", "code_information": [{"code": "15221", "type": "CPT"}, {"code": "2042285", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS GRAFT FREE W/CLOSURE DONOR SITE HEAD/CHEEK/CHIN/MOUTH/AX/GENT/HD/FT EA 20 SQ CM 15241", "code_information": [{"code": "15241", "type": "CPT"}, {"code": "2434566", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 880.55, "maximum": 8427.0, "gross_charge": 1601.0, "discounted_cash": 960.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 880.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS GRAFT TRUNK 20SQ CM OR LESS 15200", "code_information": [{"code": "15200", "type": "CPT"}, {"code": "1480964", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE 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5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS AND BOWEL", "code_information": [{"code": "48548", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS CYST AND BOWEL", "code_information": [{"code": "48520", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": 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8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", 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"standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"setting": "both", "billing_class": "facility"}]}, {"description": "FUSION DEVICE 10MM X 20MM 10DEG INTERFUSE INTERVERTEBRAL BODY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9091-10-20-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17000.0, "discounted_cash": 10200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION DEVICE 11MM X 20MM 10DEG INTERFUSE VERTEBRAL BODY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9091-11-20-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17000.0, "discounted_cash": 10200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION DEVICE 14 X 20MM PARALLEL INTERFUSE VERTEBRAL BODY", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "9091-14-20-0", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17000.0, "discounted_cash": 10200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION DEVICE 8 X 20MM 10DEG INTERFUSE INTERVERTEBRAL BODY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9091-08-20-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17000.0, "discounted_cash": 10200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION DEVICE 9MM X 20MM 10DEG INTERFUSE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "9091-09-20-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17000.0, "discounted_cash": 10200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION DEVICE INTERFUSE INTERVERTIBLE BODY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9076-07-20-5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17000.0, "discounted_cash": 10200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION DEVICE INTERFUSE S INTERVERTIBRAL BODY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9076-10-20-5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17000.0, "discounted_cash": 10200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION DEVICE INTERFUSE S INTERVERTIBRAL BODY 5DEG 9MM X 20MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "9076-09-20-5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17000.0, "discounted_cash": 10200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION DEVICE INTERVERTEBRAL 13MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9076-13-20-5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17000.0, "discounted_cash": 10200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION DEVICE INTERVERTEBRAL BODY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "JLT-S8 60 10-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9880.0, "discounted_cash": 5928.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION DEVICE INTERVERTEBRAL BODY INTERFUSE S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "9076-11-20-5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17000.0, "discounted_cash": 10200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION HAMMERTECH SX TI 10* IMPLANT SYSTEM HT-TM-6620-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HT-TM-6620-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1176.0, "discounted_cash": 705.6, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION MODULUS ALIF 8X42X32MM 15 1921086P2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1921086P2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION MODULUS ALIF FIXATION BOLT 5.0 X 20MM 1450200", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1450200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION OF ELBOW JOINT", "code_information": [{"code": "24800", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER JOINTS", "code_information": [{"code": "C7506", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28705", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF SKULL ARTERIES", "code_information": [{"code": "61711", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43810", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43820", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43825", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF TENDONS AT WRIST", "code_information": [{"code": "25300", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF TENDONS AT WRIST", "code_information": [{"code": "25301", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & BOWEL", "code_information": [{"code": "50810", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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"standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION SPINE LUMBAR POSTERIOR 22612", "code_information": [{"code": "22612", "type": "CPT"}, {"code": "1480968", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2966.15, "maximum": 14483.0, "gross_charge": 5393.0, "discounted_cash": 3235.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 2966.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION SPINE LUMBAR TRANSFORAMINAL INTERBODY 22630", "code_information": [{"code": "22630", "type": "CPT"}, {"code": "1480970", "type": "CDM"}, {"code": "360", "type": 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION SPINE THORACIC POSTERIOR 22610", "code_information": [{"code": "22610", "type": "CPT"}, {"code": "1480971", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1483.0, "maximum": 16185.0, "gross_charge": 5393.0, "discounted_cash": 3235.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", 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"standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF ELBOW JOINT", "code_information": [{"code": "24802", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUT1 GNOTYP FUT1 EXON 4", "code_information": [{"code": "185U", "type": "CPT"}], "standard_charges": [{"minimum": 460.94, "maximum": 542.31, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 542.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 460.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUT2 GNOTYP FUT2 EXON 2", "code_information": [{"code": "186U", "type": "CPT"}], "standard_charges": [{"minimum": 460.94, "maximum": 542.31, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 542.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 460.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXJL ABL LSR 1ST 100 SQ CM", "code_information": [{"code": "479T", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXN GENE ANALYSIS", "code_information": [{"code": "233U", "type": "CPT"}], "standard_charges": [{"minimum": 684.01, "maximum": 804.77, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 804.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 684.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXN GENE CHARAC ALLELES", "code_information": [{"code": "81285", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 804.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 684.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXN GENE DETC ABNOR ALLELES", "code_information": [{"code": "81284", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 330.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 297.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 221.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 51.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 43.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Fecal Leuko", "code_information": [{"code": "89055", "type": "CPT"}, {"code": "1099840", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "gross_charge": 89.0, "discounted_cash": 53.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 171.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 205.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 153.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 129.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 110.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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44.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 33.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 19.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 16.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC BANDING LAPAROSCOPIC 43770", "code_information": [{"code": "43770", "type": "CPT"}, {"code": "1480980", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3910.5, "maximum": 19020.0, "gross_charge": 7110.0, "discounted_cash": 4266.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 3910.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 10820.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 16760.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8850.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 14246.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16095.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 10988.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 19020.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17118.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC BYPASS FOR OBESITY", "code_information": [{"code": "43846", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 19020.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 10820.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 16760.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8850.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 14246.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16095.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 10988.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 19020.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17118.0, "methodology": "fee 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"0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 10820.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 16760.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8850.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 14246.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16095.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 10988.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 19020.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17118.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMPTYING IMAG STUDY", "code_information": [{"code": "78264", "type": "CPT"}], "standard_charges": [{"minimum": 956.98, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 956.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1922.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1922.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2023.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1820.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1355.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMPTYING IMAG STUDY", "code_information": [{"code": "78265", "type": "CPT"}], "standard_charges": [{"minimum": 952.48, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 952.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1913.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1913.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2013.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1812.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1349.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMPTYING IMAG STUDY", "code_information": [{"code": "78266", "type": "CPT"}], "standard_charges": [{"minimum": 1877.01, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC INTUBATION AND ASPIRATION THERAPEUTIC NECESSITATING PHYSICIAN SKILL 43753", "code_information": [{"code": "43753", "type": "CPT"}, {"code": "15213990", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, 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"plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC MUCOSA IMAGING", "code_information": [{"code": "78261", "type": "CPT"}], "standard_charges": [{"minimum": 502.86, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 502.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1009.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1009.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1063.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 956.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 712.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIN TEST", "code_information": [{"code": "82938", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 144.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 291.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 291.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 306.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 275.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 205.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 51.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 44.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROCNEMIUS RECESSION 27687", "code_information": [{"code": "27687", "type": "CPT"}, {"code": "1480981", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROESOPHAGEAL REFLUX EXAM", "code_information": [{"code": "78262", "type": "CPT"}], "standard_charges": [{"minimum": 433.16, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical 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"standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 433.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 869.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 869.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 915.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 824.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 613.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROESOPHAGEAL REFLUX TEST", "code_information": [{"code": "91034", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [{"code": "378", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7268.8, "maximum": 11182.08, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11182.08, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7268.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [{"code": "377", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13129.79, "maximum": 20622.02, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 20622.02, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13129.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC", "code_information": [{"code": "379", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4794.49, "maximum": 7221.45, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7221.45, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4794.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [{"code": "389", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6189.09, "maximum": 9091.75, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9091.75, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6189.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [{"code": "388", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11235.34, "maximum": 16671.61, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 16671.61, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11235.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC", "code_information": [{"code": "390", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4337.94, "maximum": 6206.34, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6206.34, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4337.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL REPAIR", "code_information": [{"code": "43360", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL REPAIR", "code_information": [{"code": "43361", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROPLASTY DUODENAL SWITCH", "code_information": [{"code": "43845", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 19020.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 10820.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 16760.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8850.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 14246.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16095.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 10988.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 19020.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17118.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROPLASTY W/O V-BAND", "code_information": [{"code": "43843", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 19020.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 10820.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 16760.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8850.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 14246.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16095.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 10988.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 19020.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17118.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROSTOMY LAPAROSCOPIC 43653", "code_information": [{"code": "43653", "type": "CPT"}, {"code": "1480987", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 10329.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GATED HEART MULTIPLE", "code_information": [{"code": "78473", "type": "CPT"}], "standard_charges": [{"minimum": 1446.1, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1787.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3589.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3589.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3778.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3400.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2531.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GATED HEART PLANAR SINGLE", "code_information": [{"code": "78472", "type": "CPT"}], "standard_charges": [{"minimum": 883.05, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 883.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1773.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1773.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1866.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1680.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1250.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GATIFLOXACIN 0.3% 5ML OPTH SOLN", "code_information": [{"code": "MED0500", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 254.97, "discounted_cash": 152.98, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE DEPTH / COUNTERSINK 2.5MM (YELLOW) IS1103", "code_information": [{"code": "IS1103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1124.7, "discounted_cash": 674.82, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE DEPTH ANT FXTN SYS VANTAGE", "code_information": [{"code": "870-501", "type": "CDM"}], "standard_charges": [{"gross_charge": 1626.48, "discounted_cash": 975.89, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE DEPTH FOR 150MM WIRE", "code_information": [{"code": "MSN40001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2184.0, "discounted_cash": 1310.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE DEPTH FOR 200MM WIRE", "code_information": [{"code": "MSN40003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2223.54, "discounted_cash": 1334.12, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE DEPTH FOR MINI SCREW", "code_information": [{"code": "319.11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1204.63, "discounted_cash": 722.78, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE SCREW SURGINSTR", "code_information": [{"code": "870-502", "type": "CDM"}], "standard_charges": [{"gross_charge": 850.51, "discounted_cash": 510.31, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE BANDAGE ROLL 4.5INX4.1YD 6PLY ST", "code_information": [{"code": "C-FR446S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.99, "discounted_cash": 1.79, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE BORDER 4X10 2X8PAD STERILE MSC32410", "code_information": [{"code": "MSC32410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.78, "discounted_cash": 2.87, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE BORDER 4X14 2X12PAD STERILE MSC32414", "code_information": [{"code": "MSC32414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.36, "discounted_cash": 3.22, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE BORDER 4X4 2.5X2.5PAD STERILE MSC3244", "code_information": [{"code": "MSC3244", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.28, "discounted_cash": 1.37, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE BORDER 4X8 2X6PAD STERILE MSC3248", "code_information": [{"code": "MSC3248", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.21, "discounted_cash": 2.53, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE PACKING 4IN X 36IN VAGINAL PERINEAL", "code_information": [{"code": "1-436", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.14, "discounted_cash": 12.68, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE PACKING PLAIN 1/4 NON255145H", "code_information": [{"code": "NON255145H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.3, "discounted_cash": 10.98, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE PACKING STRIP PLN 1 4X5YD 7631", "code_information": [{"code": "7631", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.49, "discounted_cash": 8.09, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE SPONGE FLUFF 4X4 12PLY STRL 2S", "code_information": [{"code": "NON25844", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.55, "discounted_cash": 0.33, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE SPONGES PREMIUM 4X4 16 PLY", "code_information": [{"code": "C-SG4416S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.96, "discounted_cash": 1.78, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE SPONGES-PREMIUM 4INX4IN 12-PLY NS", "code_information": [{"code": "C-NSG4412", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.92, "discounted_cash": 13.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE SPONGES-PREMIUM 4INX4IN 12-PLY ST", "code_information": [{"code": "C-SG4412ZS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.35, "discounted_cash": 1.41, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUZE X-RAY DETECTABLE 4X4 16 PLY", "code_information": [{"code": "C-XR4416S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.59, "discounted_cash": 2.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GBA GENE", "code_information": [{"code": "81251", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 138.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 117.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GC Probe", "code_information": [{"code": "87590", "type": "CPT"}, {"code": "1969173", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "gross_charge": 109.0, "discounted_cash": 65.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 122.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 110.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 81.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 78.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 66.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GE GNOTYP GYPC EXONS 1-4", "code_information": [{"code": "188U", "type": "CPT"}], "standard_charges": [{"minimum": 684.01, "maximum": 804.77, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 804.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 684.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GEAR DRIVER  STRAIGHT  12/14MM 651.013", "code_information": [{"code": "651.013", "type": "CDM"}], "standard_charges": [{"gross_charge": 3110.4, "discounted_cash": 1866.24, "setting": "both", "billing_class": "facility"}]}, {"description": "GEAR DRIVER  STRAIGHT  20MM 651.113", "code_information": [{"code": "651.113", "type": "CDM"}], "standard_charges": [{"gross_charge": 1637.28, "discounted_cash": 982.37, "setting": "both", "billing_class": "facility"}]}, {"description": "GEL AQUASONIC 100 60GM", "code_information": [{"code": "2-Jan", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.47, "discounted_cash": 3.88, "setting": "both", "billing_class": "facility"}]}, {"description": "GEL AQUASONIC 100 SINGLE USE 20G NS 01-20", "code_information": [{"code": "20-Jan", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.33, "discounted_cash": 0.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GEL INJECTIONS PROLARYN 1.0CC", "code_information": [{"code": "C1878", "type": "HCPCS"}, {"code": "8602MOK5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2040.0, "discounted_cash": 1224.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GEL INJECTIONS PROLARYN PLUS 1.0CC", "code_information": [{"code": "C1878", "type": "HCPCS"}, {"code": "8044MOK5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2205.0, "discounted_cash": 1323.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GEL POLAR CAREWRAP 2 PK 02874", "code_information": [{"code": "2874", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.41, "discounted_cash": 47.65, "setting": "both", "billing_class": "facility"}]}, {"description": "GEL PORT (ETHICON)", "code_information": [{"code": "HAP02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1098.3, "discounted_cash": 658.98, "setting": "both", "billing_class": "facility"}]}, {"description": "GEL SIZER MEMORY XTRA MODERATE HIGH (MHX) SMOOTH 430CC RSZ-SMHX-430S", "code_information": [{"code": "RSZ-SMHX-430S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 595.84, "discounted_cash": 357.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GEL WRAP POLAR CARE KNEE 02873", "code_information": [{"code": "2873", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.49, "discounted_cash": 33.89, "setting": "both", "billing_class": "facility"}]}, {"description": "GEL WRAP POLAR CARE SHOULDER 02877", "code_information": [{"code": "2877", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.41, "discounted_cash": 47.65, "setting": "both", "billing_class": "facility"}]}, {"description": "GELFILM 25X50MM", "code_information": [{"code": "MED0085", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 543.4, "discounted_cash": 326.04, "setting": "both", "billing_class": "facility"}]}, {"description": "GELFOAM POWDER", "code_information": [{"code": "MED0438", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 190.25, "discounted_cash": 114.15, "setting": "both", "billing_class": "facility"}]}, {"description": "GELFOAM POWDER 1GM", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "9-0433-04", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 272.3, "discounted_cash": 163.38, "setting": "both", "billing_class": "facility"}]}, {"description": "GELFOAM SIZE 100 (ABSORBABLE GELATIN)", "code_information": [{"code": "MED0086", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.88, "discounted_cash": 57.53, "setting": "both", "billing_class": "facility"}]}, {"description": "GELFOAM SIZE 50", "code_information": [{"code": "MED0087", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.24, "discounted_cash": 37.94, "setting": "both", "billing_class": "facility"}]}, {"description": "GELFOAM SPONGE 12-7MM (ABSORBABLE GELATIN)", "code_information": [{"code": "MED0088", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.5, "discounted_cash": 17.1, "setting": "both", "billing_class": "facility"}]}, {"description": "GELPOINT V-PATH TRANSVAGINAL ACCESS PLATFORM 9.5CM C2A12", "code_information": [{"code": "C2A12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 553.28, "discounted_cash": 331.97, "setting": "both", "billing_class": "facility"}]}, {"description": "GEMINUS HOOK PLATE GMN-HP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GMN-HP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1425.0, "discounted_cash": 855.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GEMINUS HOOK PLATE SCREW GMN-HP-SCRW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GMN-HP-SCRW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 336.0, "discounted_cash": 201.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GENERAL HEALTH PANEL", "code_information": [{"code": "80050", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7935.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 6744.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENTAMICIN 80MG/2 ML VIAL/GARAMYCIN", "code_information": [{"code": "MED0089", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.64, "discounted_cash": 2.78, "setting": "both", "billing_class": "facility"}]}, {"description": "GENTAMICIN OPHTHALMIC SOLUTION 3MG/ML 5ML", "code_information": [{"code": "MED0091", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 35.84, "discounted_cash": 21.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GENTAMICIN PEDIATRIC 20MG/2ML", "code_information": [{"code": "MED0221", "type": "CDM"}], "standard_charges": [{"gross_charge": 8.78, "discounted_cash": 5.27, "setting": "both", "billing_class": "facility"}]}, {"description": "GENTAMICIN TOP 0.1% OINT 15 GM", "code_information": [{"code": "MED0090", "type": "CDM"}], "standard_charges": [{"gross_charge": 133.37, "discounted_cash": 80.02, "setting": "both", "billing_class": "facility"}]}, {"description": "GFRG AUTOL FAT LIPO EA ADDL", "code_information": [{"code": "15774", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI BARRETT ESOPH 9 PRTN BMRK", "code_information": [{"code": "108U", "type": "CPT"}], "standard_charges": [{"minimum": 12319.81, "maximum": 14494.84, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 14494.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12319.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI BARRETTS ESOPH VIM&CCNA1", "code_information": [{"code": "114U", "type": "CPT"}], "standard_charges": [{"minimum": 4823.43, "maximum": 5674.99, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", 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"CIGNA DFW", "standard_charge_dollar": 1022.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 868.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI IBS IA ANTI-CDTB&VINCULIN", "code_information": [{"code": "164U", "type": "CPT"}], "standard_charges": [{"minimum": 278.79, "maximum": 328.01, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 328.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 278.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI MARKER BLUE BEACON GI Marker 5ml Syringe Indigo Carmine 0.4% Sterile 128-5667", "code_information": [{"code": "IC62021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.11, "discounted_cash": 82.27, 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{"description": "GI TRC IMG INTRAL ESOPH-ILE", "code_information": [{"code": "91110", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI TRC IMG INTRAL ESOPHAGUS", "code_information": [{"code": "91111", "type": "CPT"}], "standard_charges": [{"minimum": 1603.61, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1603.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3220.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GI WIRELESS CAPSULE MEASURE", "code_information": [{"code": "91112", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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[{"gross_charge": 344.54, "discounted_cash": 206.72, "setting": "both", "billing_class": "facility"}]}, {"description": "GIARDIA AG IF", "code_information": [{"code": "87269", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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{"description": "GRANULES <2MM 5CC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "12600401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3124.55, "discounted_cash": 1874.73, "setting": "both", "billing_class": "facility"}]}, {"description": "GRANULES BETA TRICALCIUM PHOSPHATE MED 1.4MM TO 2.8MM 5CC WHT CHRONOS STRL", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "710.014.97S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1171.26, "discounted_cash": 702.76, "setting": "both", "billing_class": "facility"}]}, {"description": "GRASPER 907-500 TANGENT EXT 907-500", "code_information": [{"code": "907-500", "type": "CDM"}], "standard_charges": [{"gross_charge": 1599.7, "discounted_cash": 959.82, "setting": "both", "billing_class": "facility"}]}, {"description": "GRASPER ALLIGATOR MINILAP GBC250", "code_information": [{"code": "GBC250", "type": "CDM"}, {"code": "272", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1097.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1097.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1154.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1039.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAMMER 2670013 SLAP HAMMER 2670013", "code_information": [{"code": "2670013", "type": "CDM"}], "standard_charges": [{"gross_charge": 1015.06, "discounted_cash": 609.04, "setting": "both", "billing_class": "facility"}]}, {"description": "HAMMER 2942049 DL SLAP HAMMER 2942049", "code_information": [{"code": "2942049", "type": "CDM"}], "standard_charges": [{"gross_charge": 1163.75, "discounted_cash": 698.25, "setting": "both", "billing_class": "facility"}]}, {"description": "HAMMER 350 GRAMS 399.41.99", "code_information": [{"code": "399.41.99", "type": "CDM"}], "standard_charges": [{"gross_charge": 1226.26, "discounted_cash": 735.76, "setting": "both", "billing_class": "facility"}]}, {"description": "HAMMER 907-405 TANGENT SLAP 907-405", "code_information": [{"code": "907-405", "type": "CDM"}], "standard_charges": [{"gross_charge": 1168.41, "discounted_cash": 701.05, "setting": "both", "billing_class": "facility"}]}, {"description": "HAMMEROTE FIXATION 2.5 X 16MM STRAIGHT 0 DEGREE OSSIO FIBER OF20025160", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OF20025160", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3892.2, "discounted_cash": 2335.32, "setting": "both", "billing_class": "facility"}]}, {"description": "HAMMERTECH TI SIZER WHEEL HT-TI-7050-S", "code_information": [{"code": "HT-TI-7050-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.16, "discounted_cash": 3.7, "setting": "both", "billing_class": "facility"}]}, {"description": "HAMMERTOE CORRECTION SYSTEM NX-3532K", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "NX-3532K", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1053.0, "discounted_cash": 631.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HAMMOCK SUBFASCIAL SLING MONARC", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "72403830", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2225.81, "discounted_cash": 1335.49, "setting": "both", "billing_class": "facility"}]}, {"description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC", "code_information": [{"code": "513", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3870.0, "maximum": 17076.52, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 17076.52, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 4732.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7533.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 3870.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 6403.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 9144.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12034.66, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 4699.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "514", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3870.0, "maximum": 11564.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11564.3, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 4732.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7533.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 3870.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 6403.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 9144.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7338.53, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 4699.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAND PROCEDURES FOR INJURIES", "code_information": [{"code": "906", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13529.09, "maximum": 24753.92, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 24753.92, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13529.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAND TENDON/MUSCLE TRANSFER", "code_information": [{"code": "26494", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HANDHELD INSTRUMENTS UC HIP 72203912", "code_information": [{"code": "72203912", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 284.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDHELD RETRACTOR-CURVED FOR SYNFIX-LR 03.802.400", "code_information": [{"code": "3.802.400", "type": "CDM"}], "standard_charges": [{"gross_charge": 872.48, "discounted_cash": 523.49, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE 1001033 FLINX STAMP HANDLE 1001033", "code_information": [{"code": "1001033", "type": "CDM"}], "standard_charges": [{"gross_charge": 486.78, "discounted_cash": 292.07, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE 2670003 WAVE DISTRACTION HANDLE 2670003", "code_information": [{"code": "2670003", "type": "CDM"}], "standard_charges": [{"gross_charge": 570.97, "discounted_cash": 342.58, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE 2942022 ACCESS HANDLE LEFT 2942022", "code_information": [{"code": "2942022", "type": "CDM"}], "standard_charges": [{"gross_charge": 931.0, "discounted_cash": 558.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE 2942050 ACCESS HANDLE RIGHT 2942050", "code_information": [{"code": "2942050", "type": "CDM"}], "standard_charges": [{"gross_charge": 931.0, "discounted_cash": 558.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE 5480140V ADJUSTABLE DRIVER 5480140V", "code_information": [{"code": "5480140V", "type": "CDM"}], "standard_charges": [{"gross_charge": 1053.36, "discounted_cash": 632.02, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE 6650250 UNIVERSAL 6650250", "code_information": [{"code": "6650250", "type": "CDM"}], "standard_charges": [{"gross_charge": 922.62, "discounted_cash": 553.57, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE 7570090 REMOVEABLE BREAK OFF 7570090", "code_information": [{"code": "7570090", "type": "CDM"}], "standard_charges": [{"gross_charge": 1061.71, "discounted_cash": 637.03, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE 7967018 TRIAL 7967018", "code_information": [{"code": "7967018", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.53, "discounted_cash": 304.52, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE 9150045 TREPHINE DRIVER 9150045", "code_information": [{"code": "9150045", "type": "CDM"}], "standard_charges": [{"gross_charge": 822.07, "discounted_cash": 493.24, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE 9150046 TREPHINE DRIVER PEAR 9150046", "code_information": [{"code": "9150046", "type": "CDM"}], "standard_charges": [{"gross_charge": 822.07, "discounted_cash": 493.24, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE 9339012 QUICK CONNECT EGG BLUE 9339012", "code_information": [{"code": "9339012", "type": "CDM"}], "standard_charges": [{"gross_charge": 1267.49, "discounted_cash": 760.49, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE 9563080 MAST MIDLF BLADE HANDLE 9563080", "code_information": [{"code": "9563080", "type": "CDM"}], "standard_charges": [{"gross_charge": 1134.0, "discounted_cash": 680.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE BACKFLUSH ACTIVE DISPOSABLE", "code_information": [{"code": "3228 handle", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.91, "discounted_cash": 97.15, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE BUCKET 0.4MM X 4MM STANDARD ROBINSON TYPE STAPES TI", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "420-400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 797.22, "discounted_cash": 478.33, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE C6908 MARKER C6908", "code_information": [{"code": "C6908", "type": "CDM"}], "standard_charges": [{"gross_charge": 407.64, "discounted_cash": 244.58, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE CATH SINUS GUIDE FOR RELIEVA FLEX SINUS GUIDE CATH RELIEVA SIDEKICK STRL", "code_information": [{"code": "SDKKLP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.74, "discounted_cash": 106.04, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE COAGULATOR SUCTION 6\" 8FR E2608-6", "code_information": [{"code": "E2608-6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.13, "discounted_cash": 33.08, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE COUNTERSINK ORTHO SURG W/ MINI QUICK COUPLING FOR USE W/ TAPS COUNTERSINK", "code_information": [{"code": "311.01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1138.89, "discounted_cash": 683.33, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE DRILL GUIDE FPS OSTEOMED", "code_information": [{"code": "323-1719", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1447.2, "discounted_cash": 868.32, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE ENDO GIA 4 STANDARD EGIAUSTND", "code_information": [{"code": "EGIAUSTND", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 617.12, "discounted_cash": 370.27, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE FOR SOFT TISSUE RETRACTOR 648.102", "code_information": [{"code": "648.102", "type": "CDM"}], "standard_charges": [{"gross_charge": 2490.48, "discounted_cash": 1494.29, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE LARYNGOSCOPE DISPOSABLE MEDIUM SLH02", "code_information": [{"code": "SLH02", "type": "CDM"}], "standard_charges": [{"gross_charge": 40.04, "discounted_cash": 24.02, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE MEDIUM CANNULATED PHALINX INST", "code_information": [{"code": "45304003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1502.72, "discounted_cash": 901.63, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE MINI FIXED AO HANDLE", "code_information": [{"code": "M19-010005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.06, "discounted_cash": 0.04, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE SCALPEL FOR MODEL 2400Z CONTROLLER UNIT", "code_information": [{"code": "70136050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1149.97, "discounted_cash": 689.98, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE SUCT YANKAUER NON VENTED OPEN TIP WITHOUT TUBING FLEXIBLE ARGYLE STRL", "code_information": [{"code": "8888501007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.96, "discounted_cash": 1.78, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE SUCTION 1 PIECE YANKAUER BULB TIP MEDIVAC STRL", "code_information": [{"code": "K86", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.34, "discounted_cash": 1.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE SUCTION YANKAUER STRAIGHT OPEN TIP STRL DISP", "code_information": [{"code": "K87", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 2.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE WITH LARGE QC 03.617.940", "code_information": [{"code": "3.617.940", "type": "CDM"}], "standard_charges": [{"gross_charge": 1092.96, "discounted_cash": 655.78, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE WITH QUICK COUPLING  SMALL 311.43.99", "code_information": [{"code": "311.43.99", "type": "CDM"}], "standard_charges": [{"gross_charge": 1018.78, "discounted_cash": 611.27, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE WITH QUICK COUPLING 311.425", "code_information": [{"code": "311.425", "type": "CDM"}], "standard_charges": [{"gross_charge": 1087.94, "discounted_cash": 652.76, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE WITH QUICK COUPLING SMALL 03.647.903", "code_information": [{"code": "3.647.903", "type": "CDM"}], "standard_charges": [{"gross_charge": 893.76, "discounted_cash": 536.26, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE WITH QUICK COUPLING- SMALL 03.617.903", "code_information": [{"code": "3.617.903", "type": "CDM"}], "standard_charges": [{"gross_charge": 1045.38, "discounted_cash": 627.23, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE WITH QUICK COUPLING- SMALL 388.396", "code_information": [{"code": "388.396", "type": "CDM"}], "standard_charges": [{"gross_charge": 1406.16, "discounted_cash": 843.7, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE YANKAUER STERILE FLEXIBLE OR61", "code_information": [{"code": "OR61", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.03, "discounted_cash": 1.22, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECE 10 DEG PULL SJ", "code_information": [{"code": "10110 Spine Jet", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4636.71, "discounted_cash": 2782.03, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECE ABLATION ENDOMETRIAL MINERVA", "code_information": [{"code": "MIN9770", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2505.6, "discounted_cash": 1503.36, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECE HYDROS HH1000", "code_information": [{"code": "C2596", "type": "HCPCS"}, {"code": "HH1000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9230.0, "discounted_cash": 5538.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECE SURG MULTI ORIFICE TIP W/ SOFT CONE SHIELD SURGILAV PLUS", "code_information": [{"code": "207-559", "type": "CDM"}], "standard_charges": [{"gross_charge": 135.2, "discounted_cash": 81.12, "setting": "both", "billing_class": "facility"}]}, {"description": "HARNESS HEAD ADULT DISPOSABLE LF 4-1054-23", "code_information": [{"code": "4-1054-23", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.13, "discounted_cash": 33.08, "setting": "both", "billing_class": "facility"}]}, {"description": "HARRIER-SASCREW5.0X25 YT30-5025", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "YT30-5025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HARVEST ALLOGENEIC STEM CELL", "code_information": [{"code": "38205", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST AUTO STEM CELLS", "code_information": [{"code": "38206", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST CULTURED SKIN GRAFT", "code_information": [{"code": "15040", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST EYE TISSUE ALOGRAFT", "code_information": [{"code": "68371", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST FEMOROPOPLITEAL VEIN", "code_information": [{"code": "35572", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST STEM CELL CONCENTRTE", "code_information": [{"code": "38215", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST VEIN FOR BYPASS", "code_information": [{"code": "35500", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", 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SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1098.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 933.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HC PRO PHONE CALL 11-20 MIN", "code_information": [{"code": "98967", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HC PRO PHONE CALL 5-10 MIN", "code_information": [{"code": "98966", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HCG FREE BETACHAIN TEST", "code_information": [{"code": "84704", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 71.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 143.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 143.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 151.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 136.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 101.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 38.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HCG TEST CLINITEST", "code_information": [{"code": "1760", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.53, "discounted_cash": 6.32, "setting": "both", "billing_class": "facility"}]}, {"description": "HCS DRIVER  2.5MM DRVR-HCS-0915", "code_information": [{"code": "DRVR-HCS-0915", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 665.0, "discounted_cash": 399.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HCS DRIVER  3.5MM DRVR-HCS-1420", "code_information": [{"code": "DRVR-HCS-1420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 825.93, "discounted_cash": 495.56, "setting": "both", "billing_class": "facility"}]}, {"description": "HDR ELCTR NTRST/NTRCV BRCHTX", "code_information": [{"code": "395T", "type": "CPT"}], "standard_charges": [{"minimum": 2685.2, "maximum": 3159.27, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3159.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2685.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HDR ELCTRNC SKN SURF BRCHYTX", "code_information": [{"code": "394T", "type": "CPT"}], "standard_charges": [{"minimum": 978.23, "maximum": 1150.94, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1150.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 978.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HDR RDNCL NTRSTL/ICAV BRCHTX", "code_information": [{"code": "77770", "type": "CPT"}], "standard_charges": [{"minimum": 996.17, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 996.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2000.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2000.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2106.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1895.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1411.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3159.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2685.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HDR RDNCL NTRSTL/ICAV BRCHTX", "code_information": [{"code": "77771", "type": "CPT"}], "standard_charges": [{"minimum": 1233.23, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1233.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2476.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2476.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2607.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2346.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1746.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3159.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2685.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HDR RDNCL NTRSTL/ICAV BRCHTX", "code_information": [{"code": "77772", "type": "CPT"}], "standard_charges": [{"minimum": 1153.07, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1153.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2315.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2315.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2437.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2193.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1633.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3159.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2685.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HDR RDNCL SKN SURF BRACHYTX", "code_information": [{"code": "77767", "type": "CPT"}], "standard_charges": [{"minimum": 286.44, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 286.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 575.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4628.0, "discounted_cash": 2776.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 12/14 36MM +8.5 CM CERAMIC DELTA IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1365-36-330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3900.0, "discounted_cash": 2340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 12/14 TAPER +5.0 36MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1365-36-320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3900.0, "discounted_cash": 2340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 22MM +6MM CEMENTED COLLARED PROXIMAL WEDGE COBALT CHROME IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7-1-2204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2297.71, "discounted_cash": 1378.63, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 28MM +12MM NECK MODULAR SKIRTED COBALT CHROME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "163666", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 28MM +9MM NECK MODULAR SKIRTED COBALT CHROME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "163665", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2598.4, "discounted_cash": 1559.04, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 28MM -3MM NECK MODULAR NO SKIRT COBALT CHROME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "163661", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 28MM STANDARD NECK BIOLOX DELTA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "12-115110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3445.0, "discounted_cash": 2067.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 3.5MM 12/14 TPR 32MM HIP ZML VRSYS LGC STRL 00-8018-032-01", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "-8018-032-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 32.0MM CERAMIC BIOLOXD OPTION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "650-1056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": 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3445.0, "discounted_cash": 2067.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 32MM NEUTRAL CEMENTED COLLARED PROXIMAL WEDGE COBALT CHROME IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7-1-3202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5200.0, "discounted_cash": 3120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 32MM STANDARD NECK MODULAR NO SKIRT COBALT CHROME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "163669", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 34 MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "497-34-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3894.78, "discounted_cash": 2336.87, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36 MM +5MM COCR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7-1-3603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36 MM CERAMIC BIOLOX DELTA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "400-03-363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7789.55, "discounted_cash": 4673.73, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36 MM DELTA CERAMIC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "400-03-361", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7789.55, "discounted_cash": 4673.73, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM +0MM 12/14 TAPER OXINUM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71343600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4628.0, "discounted_cash": 2776.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM +0MM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5-0-3602", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5200.0, "discounted_cash": 3120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM +10MM CEMENTED COLLARED PROXIMAL WEDGE COBALT CHROME IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7-1-3604", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2240.0, "discounted_cash": 1344.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM +4MM 12/14 TAPER OXINUM IMP", 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"RC"}], "standard_charges": [{"gross_charge": 3445.0, "discounted_cash": 2067.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM TAPER 12/14 CERAMIC BIOLOX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "-8775-036-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5798.55, "discounted_cash": 3479.13, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM+12 DELTA TS CERAMIC 12/14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1365-36-740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4967.3, "discounted_cash": 2980.38, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 40 MM CERA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "400-03-401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7789.55, "discounted_cash": 4673.73, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 40 MM CERAMIC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "400-03-402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7789.55, "discounted_cash": 4673.73, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 40.0MM CERAMIC BIOLOXD OPTION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "650-1058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3445.0, "discounted_cash": 2067.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 40MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "497-40-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3894.78, "discounted_cash": 2336.87, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 40MM + 8.5 DELTA TS CERAMIC 12/14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1365-40-730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3900.0, "discounted_cash": 2340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 40MM +8 BIOLOX DELTA CERAMIC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1451-040-800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2660.0, "discounted_cash": 1596.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 40MM OFFSET 1.5MM DELTA CERAMIC 12 14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1365-40-710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3900.0, "discounted_cash": 2340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 40MM OFFSET 5MM DELTA CERAMIC 12 14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1365-40-720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3900.0, "discounted_cash": 2340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL ARTICUL/EZE M-SPEC 36MM+12 12/14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1365-54-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2518.6, "discounted_cash": 1511.16, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL ARTICUL/EZE M-SPEC 36MM+8.5 12/14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1365-53-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2518.6, "discounted_cash": 1511.16, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL BIOLOX -5 32MM", "code_information": [{"code": "C1776", "type": 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"278", "type": "RC"}], "standard_charges": [{"gross_charge": 5200.0, "discounted_cash": 3120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL BIOLOX DELTA NEUTRAL 28MM +3.5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5-0-2803", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5200.0, "discounted_cash": 3120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL BIOLOX DELTA OPTION 32MM, 0MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "-8777-032-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5014.93, "discounted_cash": 3008.96, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL BIOLOX DELTA SZ 36MM X +8MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5-0-3604", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": 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"billing_class": "facility"}]}, {"description": "HEARING AID DISPENSING FEE", "code_information": [{"code": "V5090", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID DISPENSING FEE", "code_information": [{"code": "V5110", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEARING AID EXAM BOTH EARS", "code_information": [{"code": "92591", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEARING AID EXAM ONE EAR", "code_information": [{"code": "92590", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEARING LOSS DUP/DEL ANALYS", "code_information": [{"code": "81431", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1989.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1691.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEARING LOSS SEQUENCE ANALYS", "code_information": [{"code": "81430", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 4758.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4044.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FAILURE AND SHOCK WITH CC", "code_information": [{"code": "292", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6751.33, "maximum": 9767.73, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9767.73, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6751.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART FAILURE AND SHOCK WITH MCC", "code_information": [{"code": "291", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9875.24, "maximum": 14799.04, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 14799.04, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9875.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART FAILURE AND SHOCK WITHOUT CC/MCC", "code_information": [{"code": "293", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4885.5, "maximum": 6223.36, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6223.36, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4885.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS ADD-ON", "code_information": [{"code": "78496", "type": "CPT"}], "standard_charges": [{"minimum": 166.65, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 166.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 334.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 334.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 352.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 317.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 236.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS MULTIPLE", "code_information": [{"code": "78483", "type": "CPT"}], "standard_charges": [{"minimum": 863.76, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 863.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1734.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1734.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1826.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1643.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1223.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS SINGLE", "code_information": [{"code": "78481", "type": "CPT"}], "standard_charges": [{"minimum": 1389.95, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1389.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2791.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2791.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2938.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2644.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1968.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FLOW RESERVE MEASURE", "code_information": [{"code": "93571", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FLOW RESERVE MEASURE", "code_information": [{"code": "93572", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART IMAGE SPECT", "code_information": [{"code": "78494", "type": "CPT"}], "standard_charges": [{"minimum": 364.27, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 364.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 731.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 731.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 770.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 693.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 515.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE", "code_information": [{"code": "78466", "type": "CPT"}], "standard_charges": [{"minimum": 380.32, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 380.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 763.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 763.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 804.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 723.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 538.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE (3D)", "code_information": [{"code": "78469", "type": "CPT"}], "standard_charges": [{"minimum": 426.64, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 426.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 856.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 856.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 902.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 811.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 604.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE (EF)", "code_information": [{"code": "78468", "type": "CPT"}], "standard_charges": [{"minimum": 756.54, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 756.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1519.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1519.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1599.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1439.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1071.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART PACING MAPPING", "code_information": [{"code": "93631", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 15456.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART REVASCULARIZE (TMR)", "code_information": [{"code": "33140", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART RHYTHM PACING", "code_information": [{"code": "93618", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 15456.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART TMR W/OTHER PROCEDURE", "code_information": [{"code": "33141", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC", "code_information": [{"code": "1", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 54.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 59.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 44.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "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": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC", "code_information": [{"code": "2", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 54.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 59.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 44.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "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": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART/LUNG RESUSCITATION CPR", "code_information": [{"code": "92950", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAT BIOLOX SHORT -5 28MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "136-2801", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2128.0, "discounted_cash": 1276.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAT QUANT SENSORY TEST", "code_information": [{"code": "109T", "type": "CPT"}], "standard_charges": [{"minimum": 32.59, "maximum": 68.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 65.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 65.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 68.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 62.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAVY METAL QUAL ANY ANAL", "code_information": [{"code": "83015", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 140.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 281.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 281.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 296.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 266.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 198.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 61.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 52.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAVY METAL QUANT EACH NES", "code_information": [{"code": "83018", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 78.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 158.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 158.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 166.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 150.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 111.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 64.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 54.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEDRON C SPACER 12X14 7MM 7 1211.2417S", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "1211.2417S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2520.0, "discounted_cash": 1512.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEDRON C SPACER 14X16 10MM 7 1211.4620S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1211.4620S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2520.0, "discounted_cash": 1512.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEDRON IA SPACER 29X39 15MM 8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1212.1115S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 6600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEINZ BODIES DIRECT", "code_information": [{"code": "85441", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 69.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 69.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 72.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 65.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 48.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 12.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 10.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEINZ BODIES INDUCED", "code_information": [{"code": "85445", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 57.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 115.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 115.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 129.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 38.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 32.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM AHUS GEN SEQ ALYS 15 GEN", "code_information": [{"code": "268U", "type": "CPT"}], "standard_charges": [{"minimum": 1513.64, "maximum": 1780.87, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1780.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1513.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM AUT DM CGEN TRMBCTPNA 22", "code_information": [{"code": "269U", 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"standard_charges": [{"minimum": 1513.64, "maximum": 1780.87, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1780.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1513.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM GEN HYPRFIBRNLYSIS 8 GEN", "code_information": [{"code": "273U", "type": "CPT"}], "standard_charges": [{"minimum": 1513.64, "maximum": 1780.87, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1780.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1513.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM GEN PLTLT DO 62 GENES", "code_information": [{"code": "274U", "type": "CPT"}], 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"standard_charges": [{"minimum": 45.72, "maximum": 53.79, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 53.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 45.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM INH THROMBOCYTOPENIA 42", "code_information": [{"code": "276U", "type": "CPT"}], "standard_charges": [{"minimum": 6094.08, "maximum": 7169.98, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7169.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 6094.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEM VW FACTOR&CLGN III BNDG", "code_information": [{"code": "279U", "type": "CPT"}], "standard_charges": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 132.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 132.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 139.46, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 770.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1547.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1547.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1629.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1466.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1091.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1093.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 929.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMATOPOIETIC PROGENITOR CELL ALLOGENEIC TRANPLANTATION PER DONOR 38240", "code_information": [{"code": "38240", "type": "CPT"}, 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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"standard_charge_dollar": 607.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 546.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 407.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 114.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 97.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS G DNA DIR PROBE", "code_information": [{"code": "87525", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 164.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 329.76, "methodology": "fee 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 232.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 87.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 74.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS G DNA QUANT", "code_information": [{"code": "87527", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 232.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 466.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 466.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 491.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 442.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 329.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 122.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 103.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATOBIL SYST IMAGE W/DRUG", "code_information": [{"code": "78227", "type": "CPT"}], "standard_charges": [{"minimum": 1077.36, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1077.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2163.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2163.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2277.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2049.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1526.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC", "code_information": [{"code": "421", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13058.59, "maximum": 18573.66, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 18573.66, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13058.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC", "code_information": [{"code": "420", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25819.18, "maximum": 40031.59, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 40031.59, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 25819.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "422", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11065.78, "maximum": 16665.93, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 16665.93, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11065.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATOBILIARY SYSTEM IMAGING", "code_information": [{"code": "78226", "type": "CPT"}], "standard_charges": [{"minimum": 1051.85, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1051.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2112.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2112.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2223.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2001.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1489.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATOTOMY FOR OPEN DRAINAGE OF ABCESS-STAGE 1 OR 2 47010", "code_information": [{"code": "47010", "type": "CPT"}, {"code": "1481016", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATOTOMY RESECTION OF LIVER-PARTIAL LOBECTOMY 47120", "code_information": [{"code": "47120", "type": "CPT"}, {"code": "1481017", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET 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"HOLLOW LUMEN SUTURE PASSER 64416008A", "code_information": [{"code": "64416008A", "type": "CDM"}], "standard_charges": [{"gross_charge": 1131.84, "discounted_cash": 679.1, "setting": "both", "billing_class": "facility"}]}, {"description": "HOLZHEIMER RETRACTOR W/ BLUNT PRONGS 67590002", "code_information": [{"code": "67590002", "type": "CDM"}], "standard_charges": [{"gross_charge": 1292.76, "discounted_cash": 775.66, "setting": "both", "billing_class": "facility"}]}, {"description": "HOLZHEIMER RETRACTOR W/ SHARP PRONGS 67590001", "code_information": [{"code": "67590001", "type": "CDM"}], "standard_charges": [{"gross_charge": 1292.76, "discounted_cash": 775.66, "setting": "both", "billing_class": "facility"}]}, {"description": "HOMATROPINE HYDROBROMIDE 5% OPHTH SOLUTION 5ML", "code_information": [{"code": "MED0291", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 98.4, "discounted_cash": 59.04, "setting": "both", "billing_class": "facility"}]}, {"description": "HOME ENVIRONMENT ASSESSMENT", "code_information": [{"code": "T1028", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME EPISODIC CASE 30 DAYS", "code_information": [{"code": "S0272", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOME HEALTH CARE SUPERVISION", "code_information": [{"code": "99374", "type": 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"billing_class": "facility"}]}, {"description": "HOME SLEEP TEST/TYPE 3 PORTA", "code_information": [{"code": "G0399", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "HOME SLEEP TEST/TYPE 4 PORTA", "code_information": [{"code": "G0400", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME/RES VST EST HIGH MDM 60", "code_information": [{"code": "99350", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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{"description": "HOOK  OFFSET  RIGHT 7726-4509", "code_information": [{"code": "7726-4509", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOK  PEDICLE  SMALL 7721-0707", "code_information": [{"code": "7721-0707", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOK  PEDICLE  SMALL 7721-0909", "code_information": [{"code": "7721-0909", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOK  RAMPED BLADE 7723-0508", "code_information": [{"code": "7723-0508", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOK  SMALL 7903-1045", "code_information": [{"code": 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101-80026", "code_information": [{"code": "101-80026", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOKS PEDICLE S 2901-80043", "code_information": [{"code": "2901-80043", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOKS PEDICLE SERRATED  S 101-80029", "code_information": [{"code": "101-80029", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOKS THORACIC LAMINAR ANGLED  LEFT 2901-80023", "code_information": [{"code": "2901-80023", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOKS THORACIC LAMINAR ANGLED  RIGHT 2901-80024", "code_information": 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STANDARD 3001-80401", "code_information": [{"code": "3001-80401", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOKS THORACIC LAMINAR L NARROW 101-80020", "code_information": [{"code": "101-80020", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOKS THORACIC LAMINAR L STANDARD 101-80021", "code_information": [{"code": "101-80021", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOKS THORACIC LAMINAR L STANDARD 2901-80020", "code_information": [{"code": "2901-80020", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOKS THORACIC LAMINAR LATERAL GRIP 101-80043", "code_information": [{"code": "101-80043", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOKS THORACIC LAMINAR OFFSET  LEFT 2901-80021", "code_information": [{"code": "2901-80021", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOKS THORACIC LAMINAR OFFSET  RIGHT 2901-80022", "code_information": [{"code": "2901-80022", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOKS THORACIC LAMINAR OFFSET LEFT 101-80022", "code_information": [{"code": "101-80022", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOKS THORACIC LAMINAR OFFSET RIGHT 101-80023", "code_information": [{"code": "101-80023", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOKS THORACIC LAMINAR S NARROW 101-80018", "code_information": [{"code": "101-80018", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOKS THORACIC LAMINAR S STANDARD 101-80019", "code_information": [{"code": "101-80019", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOKS TRANSVERSE PROCESS 10 MM 801-81001H", "code_information": [{"code": "801-81001H", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOKS TRANSVERSE PROCESS 6 MM 801-80601H", 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"2901-80033", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOP CURETTE-STRAIGHT BAYONETED 03.605.510", "code_information": [{"code": "3.605.510", "type": "CDM"}], "standard_charges": [{"gross_charge": 1890.0, "discounted_cash": 1134.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOP RETRACT 6.25MM SHIM MS TLIP", "code_information": [{"code": "3400021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1610.39, "discounted_cash": 966.23, "setting": "both", "billing_class": "facility"}]}, {"description": "HOSP IP/OBS DSCHRG MGMT 30/<", "code_information": [{"code": "99238", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1032.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 929.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 691.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1712.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1455.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HSV 1/2 PCR", "code_information": [{"code": "87529", "type": "CPT"}, {"code": "1099839", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "gross_charge": 140.0, "discounted_cash": 84.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 164.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 329.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 329.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 347.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 312.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 232.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 58.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1399.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2810.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2810.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2958.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2662.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1982.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5810.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", 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8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1972.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1775.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1321.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5810.01, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 75.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 26.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 22.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTLV-II ANTIBODY", "code_information": [{"code": "86688", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 529.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 394.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 401.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 340.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMAN EPIDIDYMIS PROTEIN 4", "code_information": [{"code": "86305", "type": "CPT"}], 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"BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYOID MYOTOMY & SUSPENSION", "code_information": [{"code": "21685", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERBARIC OXYGEN THERAPY", "code_information": [{"code": "99183", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTENSION WITH MCC", "code_information": [{"code": "304", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7935.27, "maximum": 13324.58, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13324.58, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7935.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTENSION WITHOUT MCC", "code_information": [{"code": "305", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5284.07, "maximum": 8514.44, "estimated_discounted_cash": 7265.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 8514.44, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5284.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTENSIVE ENCEPHALOPATHY WITH CC", "code_information": [{"code": "78", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7120.53, "maximum": 11318.18, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11318.18, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7120.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTENSIVE ENCEPHALOPATHY WITH MCC", "code_information": [{"code": "77", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11391.68, "maximum": 17538.13, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 17538.13, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11391.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC", "code_information": [{"code": "79", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5479.31, "maximum": 7503.87, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7503.87, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5479.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77600", "type": "CPT"}], "standard_charges": [{"minimum": 663.81, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 663.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1333.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1333.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1403.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1263.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 940.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1150.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 978.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77605", "type": "CPT"}], "standard_charges": [{"minimum": 2685.2, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3159.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2685.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77610", "type": "CPT"}], "standard_charges": [{"minimum": 2129.92, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2505.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2129.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77615", "type": "CPT"}], "standard_charges": [{"minimum": 2129.92, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2505.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2129.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77620", "type": "CPT"}], "standard_charges": [{"minimum": 2129.92, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2505.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2129.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPNOTHERAPY", "code_information": [{"code": "90880", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", 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"AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], 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{"description": "IADNA VAG PTHGN PANEL 27 ORG", "code_information": [{"code": "330U", "type": "CPT"}], "standard_charges": [{"minimum": 1037.31, "maximum": 1220.45, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1220.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1037.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA-DNA/RNA PROBE TQ 12-25", "code_information": [{"code": "87507", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILIAC ART ANGIO,CARDIAC CATH", "code_information": [{"code": "G0278", "type": "HCPCS"}], "standard_charges": [{"minimum": 6752.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, 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"standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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1176.12, "discounted_cash": 705.67, "setting": "both", "billing_class": "facility"}]}, {"description": "ILLUMINATOR OPTHALMIC 25GA CHANDELIER 8065751577", "code_information": [{"code": "8065751577", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 398.29, "discounted_cash": 238.97, "setting": "both", "billing_class": "facility"}]}, {"description": "ILLUMINATOR OPTIC 20GA FIBER SHIELDED WIDE ANGLE BULLET", "code_information": [{"code": "8065109203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 102.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ILLUMINATOR SINGLE USE DISP", "code_information": [{"code": "6133.0605", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5546.88, "discounted_cash": 3328.13, "setting": "both", "billing_class": "facility"}]}, {"description": "ILLUMINATOR SURGICAL LUMITEX", "code_information": [{"code": "38-LIGHT-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1064.0, "discounted_cash": 638.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ILOPROST NON-COMP UNIT DOSE", "code_information": [{"code": "Q4074", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IM ADMIN 1ST/ONLY COMPONENT", "code_information": [{"code": "90460", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM ADMIN EACH ADDL COMPONENT", "code_information": [{"code": "90461", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER CMPL", "code_information": [{"code": "263T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER HRVST ONL", "code_information": [{"code": "265T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER XCL HRVST", "code_information": [{"code": "264T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID COLXN VISC", "code_information": [{"code": "49405", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID PERI/RETRO", "code_information": [{"code": "49406", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID TRNS/VGNL", "code_information": [{"code": "49407", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMAGE GUIDED PLACEMENT METALLIC LOCAL CLIP PERCUTANEOUS DURING BREAST BX 19295", "code_information": [{"code": "2025477", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "billing_class": "facility"}]}, {"description": "IMATINIB 100 MG", "code_information": [{"code": "S0088", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMFLUOR EA ADDL 1ANTB STN PX", "code_information": [{"code": "88350", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 131.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 264.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 264.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 278.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 250.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 186.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 260.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 221.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMG GID FLU COLL DRG SFT TIS", "code_information": [{"code": "10030", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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10400.0, "discounted_cash": 6240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMP VILEX TOV 8MM SUBTALAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TOV1-08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9162.4, "discounted_cash": 5497.44, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR 1001001 FLINX BONE GRFT IMPACTR 1001001", "code_information": [{"code": "1001001", "type": "CDM"}], "standard_charges": [{"gross_charge": 414.96, "discounted_cash": 248.98, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR 12MM X 12MM 200MM LENGTH/230MM HANDLE 389.697", "code_information": [{"code": "389.697", "type": "CDM"}], "standard_charges": [{"gross_charge": 1976.4, "discounted_cash": 1185.84, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR 12MM X 12MM 250MM LENGTH/230MM HANDLE 389.696", "code_information": [{"code": "389.696", "type": "CDM"}], "standard_charges": [{"gross_charge": 2244.24, "discounted_cash": 1346.54, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR 12MM X 20MM 389.75", "code_information": [{"code": "389.75", "type": "CDM"}], "standard_charges": [{"gross_charge": 2248.56, "discounted_cash": 1349.14, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR 388.755", "code_information": [{"code": "388.755", "type": "CDM"}], "standard_charges": [{"gross_charge": 1162.42, "discounted_cash": 697.45, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR 6481005 STAPLE 6481005", "code_information": [{"code": "6481005", "type": "CDM"}], "standard_charges": [{"gross_charge": 1215.0, "discounted_cash": 729.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR 665.607", "code_information": [{"code": "665.607", "type": "CDM"}], "standard_charges": [{"gross_charge": 1050.7, "discounted_cash": 630.42, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR 6660078 CRESCENT TI 7/8 MM 6660078", "code_information": [{"code": "6660078", "type": "CDM"}], "standard_charges": [{"gross_charge": 575.6, "discounted_cash": 345.36, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR 6660910 CRESCENT TI 9/10MM 6660910", "code_information": [{"code": "6660910", "type": "CDM"}], "standard_charges": [{"gross_charge": 575.6, "discounted_cash": 345.36, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR 6661112 CRESCENT TI 11/12MM 6661112", "code_information": [{"code": "6661112", "type": "CDM"}], "standard_charges": [{"gross_charge": 575.6, "discounted_cash": 345.36, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR 6661314 CRESCENT TI 13/14MM 6661314", "code_information": [{"code": "6661314", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 575.6, "discounted_cash": 345.36, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR 6661516 CRESCENT TI 15/16MM 6661516", "code_information": [{"code": "6661516", "type": "CDM"}], "standard_charges": [{"gross_charge": 575.6, "discounted_cash": 345.36, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR 7509013 15 DEG 7509013", "code_information": [{"code": "7509013", "type": "CDM"}], "standard_charges": [{"gross_charge": 1123.2, "discounted_cash": 673.92, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR 7509015 45 DEG 7509015", "code_information": [{"code": "7509015", "type": "CDM"}], "standard_charges": [{"gross_charge": 1123.2, "discounted_cash": 673.92, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR 893-597 20MM ATTACHMENT 893-597", "code_information": [{"code": "893-597", "type": "CDM"}], "standard_charges": [{"gross_charge": 340.65, "discounted_cash": 204.39, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR 9090003 HOUSING 9090003", "code_information": [{"code": "9090003", "type": "CDM"}], "standard_charges": [{"gross_charge": 2705.72, "discounted_cash": 1623.43, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR 909004 HOUSING 9090004", "code_information": [{"code": "9090004", "type": "CDM"}], "standard_charges": [{"gross_charge": 2989.87, "discounted_cash": 1793.92, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR CAP I-076", "code_information": [{"code": "I-076", "type": "CDM"}], "standard_charges": [{"gross_charge": 452.2, "discounted_cash": 271.32, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR CURVED 389.856", "code_information": [{"code": "389.856", "type": "CDM"}], "standard_charges": [{"gross_charge": 2358.72, "discounted_cash": 1415.23, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR SMALL/ANGLED 397.024", "code_information": [{"code": "397.024", "type": "CDM"}], "standard_charges": [{"gross_charge": 2658.96, "discounted_cash": 1595.38, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR SMALL/EXTENDED 389.079", "code_information": [{"code": "389.079", "type": "CDM"}], "standard_charges": [{"gross_charge": 641.06, "discounted_cash": 384.64, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR SMALL/STRAIGHT 396.398", "code_information": [{"code": "396.398", "type": "CDM"}], "standard_charges": [{"gross_charge": 2417.04, "discounted_cash": 1450.22, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR STRAIGHT 389.855", "code_information": [{"code": "389.855", "type": "CDM"}], "standard_charges": [{"gross_charge": 2358.72, "discounted_cash": 1415.23, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR-BALL TIP 03.617.982", "code_information": [{"code": "3.617.982", "type": "CDM"}], "standard_charges": [{"gross_charge": 1213.92, "discounted_cash": 728.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR-BALL TIP 03.647.982", "code_information": [{"code": "3.647.982", "type": "CDM"}], "standard_charges": [{"gross_charge": 1141.14, "discounted_cash": 684.68, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR-CURVED/STANDARD BAYONETED 03.605.532", "code_information": [{"code": "3.605.532", "type": "CDM"}], "standard_charges": [{"gross_charge": 2023.92, "discounted_cash": 1214.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR-CURVED/TALL 389.831", "code_information": [{"code": "389.831", "type": "CDM"}], "standard_charges": [{"gross_charge": 2358.72, "discounted_cash": 1415.23, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR-CURVED/TALL BAYONETED 03.605.533", "code_information": [{"code": "3.605.533", "type": "CDM"}], "standard_charges": [{"gross_charge": 2023.92, "discounted_cash": 1214.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR-FLAT 03.617.981", "code_information": [{"code": "3.617.981", "type": "CDM"}], "standard_charges": [{"gross_charge": 1213.92, "discounted_cash": 728.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR-STANDARD BAYONETED 03.605.500", "code_information": [{"code": "3.605.500", "type": "CDM"}], "standard_charges": [{"gross_charge": 2023.92, "discounted_cash": 1214.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR-TALL BAYONETED 03.605.531", "code_information": [{"code": "3.605.531", "type": "CDM"}], "standard_charges": [{"gross_charge": 2023.92, "discounted_cash": 1214.35, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPALNT SIZE 5  TIBIAL BERING INSERT TRIATHLON CR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-509-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 1680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPANT GUIDE WIRE .045 X 4 XGP4045", "code_information": [{"code": "XGP4045", "type": "CDM"}], "standard_charges": [{"gross_charge": 278.08, "discounted_cash": 166.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPIX-TLIF 11 MM AT 6DEG WITH LEAD B15130611S", "code_information": [{"code": "B15130611S", "type": "CDM"}], "standard_charges": [{"gross_charge": 5720.0, "discounted_cash": 3432.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPIX-TLIF 13 MM AT 6DEG WITH LEAD B15130613S", "code_information": [{"code": "B15130613S", "type": "CDM"}], "standard_charges": [{"gross_charge": 5720.0, "discounted_cash": 3432.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPIX-TLIF 15 MM AT 6DEG WITH LEAD B15130615S", "code_information": [{"code": "B15130615S", "type": "CDM"}], "standard_charges": [{"gross_charge": 5720.0, "discounted_cash": 3432.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPIX-TLIF 7 MM AT 6DEG WITH LEAD B15130607S", "code_information": [{"code": "B15130607S", "type": "CDM"}], "standard_charges": [{"gross_charge": 5720.0, "discounted_cash": 3432.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPIX-TLIF 9 MM AT 6DEG WITH LEAD B15130609S", "code_information": [{"code": "B15130609S", "type": "CDM"}], "standard_charges": [{"gross_charge": 5720.0, "discounted_cash": 3432.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPL ABSRB MSH/PRSTH DLY CLS", "code_information": [{"code": "15778", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL CROSS LINK 30MM UNIVERSAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "UCL3030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6110.0, "discounted_cash": 3666.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPL CROSS LINK 35MM UNIVERSAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "UCL3535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6110.0, "discounted_cash": 3666.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPL FEMORAL SIGMA SZ 3 LFT POST STAB CEMENTED", "code_information": [{"code": "C1776", "type": 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8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "64553", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROSTIM ARRAYS", "code_information": [{"code": "61886", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 63075.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 36437.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", 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{"code": "70142156", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 795.0, "discounted_cash": 477.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SURG 13.5MM X 30MM X 38MM SYNFIX", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "8.802.008S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22940.0, "discounted_cash": 13764.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SURG 13MM SHARK PLIF", "code_information": [{"code": "PP20-32130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 6600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SURG 18MM ENCOMPASS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "385-0018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7010.59, 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"facility"}]}, {"description": "IMPLANT SURG 8MM MAGENTA SUBTALAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TOV3-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6544.2, "discounted_cash": 3926.52, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SURG 9MM 10DEG PEEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "L2-ACIF10-09P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8555.52, "discounted_cash": 5133.31, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SURG 9MM 5DEG PEEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "L2ACIF05-09P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6843.82, "discounted_cash": 4106.29, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SURG 9MM TALAR FIT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "340-0002-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5712.34, "discounted_cash": 3427.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SURG LG 5DEG HTO IBALANCE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-13400L-05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7059.0, "discounted_cash": 4235.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SUTUREGROOVE GOLD EYELID 1.4G SLIM", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "GSLM-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 719.03, "discounted_cash": 431.42, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SYS BIOC ACHILLES W/JUMP AR-8928BCJ-CP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8928BCJ-CP", "type": 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{"description": "IMPLANT SYSTEM NASAL LATERA ABSORBABLE", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "LATSYS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2786.0, "discounted_cash": 1671.6, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SYSTEM TI PETITE HT-TM-5510-S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HT-TM-5510-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3120.0, "discounted_cash": 1872.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SZ 3 FINGER JOINT W/ GROMMETS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "G4700003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3348.8, "discounted_cash": 2009.28, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SZE 4   X 9MM TIBIAL BEARING INSERT", 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[{"gross_charge": 6448.0, "discounted_cash": 3868.8, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT TCAT PULM VLV PERQ", "code_information": [{"code": "33477", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 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"CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANTS 3.5MM LOCKING SCREW SLF-TPING W/STARDRIVE(TM) RECESS 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 491.36, "discounted_cash": 294.82, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANTS FEMORAL PS-C SZ3 LFT", "code_information": [{"code": "161-1303", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7270.25, "discounted_cash": 4362.15, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANTS FEMORAL PS-C SZ3 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "161-1304", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7270.25, "discounted_cash": 4362.15, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANTS GLENOSPHERE 33 +4 LAT/24", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9564-2433-LAT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2254.0, "discounted_cash": 1352.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANTS LAPIPLASTY MINI-INCISION SYSTEM SK30", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10440.0, "discounted_cash": 6264.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANTS PROSTHESIS PENL SCROTAL 20CM TITAN ZERO DEGREE ANGLE PUMP SET", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "ES8920", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 21464.0, "discounted_cash": 12878.4, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANTS TMJ BILATERAL BUNDLED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CHG020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 36960.0, "discounted_cash": 22176.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANTS TOTAL HIP RPLCMT ZIMMER E-POLY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "98000150055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25000.0, "discounted_cash": 15000.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANTS TOTAL KNEE ZIMMER PERSONALIZED SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "98000241520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 27400.0, "discounted_cash": 16440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLT ANT SGM IO NBIO RX SYS", "code_information": [{"code": "660T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 9391.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 9391.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7982.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT BRAIN CHEMOTX ADD-ON", "code_information": [{"code": "61517", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT CRAN BONE FLAP TO ABDO", "code_information": [{"code": "61316", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 37880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34092.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV LEAD", "code_information": [{"code": "267T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV TOTAL", "code_information": [{"code": "266T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 37880.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 37880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34092.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLTJ NTRSTRML CRNL RNG SEG", "code_information": [{"code": "65785", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLTJ SYNTH RNFCMT ABDL WAL", "code_information": [{"code": "437T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE 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"facility"}]}, {"description": "INBORN AND OTHER DISORDERS OF METABOLISM", "code_information": [{"code": "642", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9274.09, "maximum": 14076.56, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 14076.56, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9274.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCAL BX SKN EA SEP/ADDL", "code_information": [{"code": "11107", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS 1 VERTEBRAL SEG THORAC", "code_information": [{"code": "22212", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS ADDL SPINE SEGMENT", "code_information": [{"code": "22216", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN ADL SEG", "code_information": [{"code": "22208", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN LUMBAR", "code_information": [{"code": "22207", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN THORAC", "code_information": [{"code": "22206", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE & TREAT BLADDER", "code_information": [{"code": "51030", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE BILE DUCT SPHINCTER", "code_information": [{"code": "47460", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE DIAPHRAGM NERVE", "code_information": [{"code": "64746", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE FLEXOR CARPI RADIALIS", "code_information": [{"code": "25001", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE HIP/THIGH NERVE", "code_information": [{"code": "64763", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE HIP/THIGH NERVE", "code_information": [{"code": "64766", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EAR", "code_information": [{"code": "69801", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65880", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE NERVE BACK OF HEAD", "code_information": [{"code": "64744", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL (PRESS RELIEF)", "code_information": [{"code": "61343", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR BRAIN WOUND", "code_information": [{"code": "61458", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR BRAIN WOUND", "code_information": [{"code": "61571", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR SURGERY", "code_information": [{"code": "61450", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR SURGERY", "code_information": [{"code": "61460", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR TREATMENT", "code_information": [{"code": "61770", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL REPAIR", "code_information": [{"code": "62121", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN BIOPSY", "code_information": [{"code": "61750", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN SURGERY", "code_information": [{"code": "61720", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN SURGERY", "code_information": [{"code": "61735", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/SUTURES", "code_information": [{"code": "61556", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/SUTURES", "code_information": [{"code": "61557", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY 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{"description": "INCISE SPINAL CORD TRACT(S)", "code_information": [{"code": "63170", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SPINE ACCESSORY NERVE", "code_information": [{"code": "63191", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN EYELID LINING", "code_information": [{"code": "68020", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN TEAR GLAND", "code_information": [{"code": "68400", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE ABSCESS; PERITONSILLAR 42700", "code_information": [{"code": "42700", "type": "CPT"}, {"code": "41583337", 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"plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAGE BELOW FASCIA FOOT 28002", "code_information": [{"code": "28002", "type": "CPT"}, {"code": "2401694", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO 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3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF BILE DUCT", "code_information": [{"code": "47420", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF BILE DUCT", "code_information": [{"code": "47425", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF BRAIN TISSUE", "code_information": [{"code": "61541", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF BRAIN TISSUE", "code_information": [{"code": "61567", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER 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"maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF BURN SCAB INITI", "code_information": [{"code": "16035", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF CHEEK NERVE", "code_information": [{"code": "64734", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF CHIN NERVE", "code_information": [{"code": "64736", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"facility"}]}, {"description": "INCISION OF COLLARBONE JOINT", "code_information": [{"code": "23106", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF ESOPHAGUS", "code_information": [{"code": "43020", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYELID", "code_information": [{"code": "67710", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF FACIAL NERVE", "code_information": [{"code": "64742", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF FINGER TENDON", "code_information": [{"code": "26060", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF 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combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF GALLBLADDER", "code_information": [{"code": "47490", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEART SAC", "code_information": [{"code": "33020", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEART SAC", "code_information": [{"code": "33025", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP BONE", "code_information": [{"code": "27146", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP BONES", "code_information": [{"code": "27151", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27003", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF IRIS", "code_information": [{"code": "66505", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF JAW JOINT", "code_information": [{"code": "21010", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF JAW NERVE", "code_information": [{"code": "64738", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", 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SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF LABIAL FRENUM (FRENOTOMY) 40806", "code_information": [{"code": "40806", "type": "CPT"}, {"code": "1481078", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF LARGE BOWEL", "code_information": [{"code": "44025", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF LINGUAL FRENUM 41010", "code_information": [{"code": "41010", "type": "CPT"}, {"code": "10956178", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1541.95, "maximum": 8427.0, "gross_charge": 2803.56, "discounted_cash": 1682.14, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1541.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF LIVER DUCT", "code_information": [{"code": "47400", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF LYMPH CHANNELS", "code_information": [{"code": "38308", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF NECK OF FEMUR", "code_information": [{"code": "27161", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF PYLORIC MUSCLE", "code_information": [{"code": "43520", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 9519.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF RECTAL ABSCESS", "code_information": [{"code": "46045", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF RECTAL ABSCESS", "code_information": [{"code": "46060", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27391", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27392", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee 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"plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF TONGUE NERVE", "code_information": [{"code": "64740", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31600", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, 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billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31610", 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{"description": "INCISION/FIXATION OF FEMUR", "code_information": [{"code": "27165", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee 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"standard_charges": [{"minimum": 843.7, "maximum": 8427.0, "gross_charge": 1534.0, "discounted_cash": 920.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISIONAL BIOPSY OF SALIVARY GLAND 42405", "code_information": [{"code": "42405", "type": "CPT"}, {"code": "29499174", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", 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"standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRATEMPORAL APPROACH/SKULL", "code_information": [{"code": "61591", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFUMORPH/MORPHINE PF 200MG/20ML INJ", "code_information": [{"code": "MED0600", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 453.38, "discounted_cash": 272.03, "setting": "both", "billing_class": "facility"}]}, {"description": "INFUSE KIT  BONE GRAFT SMALL 7510200", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "7510200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11206.0, "discounted_cash": 6723.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INFUSE KIT BONE GRAFT  X SMALL 7510100", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "7510100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3868.8, "discounted_cash": 2321.28, "setting": "both", "billing_class": "facility"}]}, {"description": "INFUSE RADIOACTIVE MATERIALS", "code_information": [{"code": "77750", "type": "CPT"}], "standard_charges": [{"minimum": 493.25, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 493.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 990.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 990.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1042.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 938.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 698.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1150.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 978.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFUSION BAG INFU-SURG NOVA PRESSURE  1000 ML 4010H", "code_information": [{"code": "4010H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.01, "discounted_cash": 35.41, "setting": "both", "billing_class": "facility"}]}, {"description": "INFUSION INSULIN PUMP NEEDLE", "code_information": [{"code": "A4231", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFUSOR PRESSURE 1000CC IN900012", "code_information": [{"code": "IN900012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 101.96, "discounted_cash": 61.18, "setting": "both", "billing_class": "facility"}]}, {"description": "INFUSOR PRESSURE 500 ML CLR CUFF", "code_information": [{"code": "MX4705", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.84, "discounted_cash": 47.3, "setting": "both", "billing_class": "facility"}]}, {"description": "INGEST CHALLENGE ADDL 60 MIN", "code_information": [{"code": "95079", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INGEST CHALLENGE INI 120 MIN", "code_information": [{"code": "95076", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC", "code_information": [{"code": "351", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11010.73, "maximum": 17064.04, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 17064.04, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11010.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC", "code_information": [{"code": "350", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17957.31, "maximum": 27432.9, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 27432.9, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 17957.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "352", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7732.69, "maximum": 12505.69, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 12505.69, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7732.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INGUINOFEMORAL LYMPHADENECTOMY SUPERFICIAL CLOQUETS NODE 38760", "code_information": [{"code": "38760", "type": "CPT"}, {"code": "1900990", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INHIBIN A", "code_information": [{"code": "86336", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 83.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 168.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 168.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 176.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 159.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 118.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 45.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 38.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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"plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FE-BASED MR CONTRAST,1ML", "code_information": [{"code": "Q9953", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ FOLLITROPIN BETA 75 IU", "code_information": [{"code": "S0128", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ GANIRELIX ACETAT 250 MCG", "code_information": [{"code": "S0132", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ MENOTROPINS 75 IU", "code_information": [{"code": "S0122", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PANTOPRAZOLE SODIUM, VIA", "code_information": [{"code": "C9113", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ W/FLUOR EVAL CV DEVICE", "code_information": [{"code": "36598", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": 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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": 103.4, "maximum": 14483.0, "gross_charge": 188.0, "discounted_cash": 112.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 103.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ.ANESTHETIC AGENT AND/OR STEROID; LUMBAR/SACRAL 64483", "code_information": [{"code": "64483", "type": "CPT"}, {"code": "1481088", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "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": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "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": 1659.0, "maximum": 8427.0, "gross_charge": 3279.0, "discounted_cash": 1967.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1803.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT FOR LYMPHATIC X-RAY", "code_information": [{"code": "38790", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT FOR SACROILIAC JOINT", "code_information": [{"code": "G0259", "type": "HCPCS"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT SKIN LESIONS >7", "code_information": [{"code": "11901", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT/ASPIRATE LIVER CYST", "code_information": [{"code": "47015", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67500", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67505", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67515", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTABLE BONE SUBSTITUTE CALCIUM PHOSPHATE 5ML", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "201.05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6552.0, "discounted_cash": 3931.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECTABLE CLARIX FLOW 25MG", "code_information": [{"code": "Q4155", "type": "HCPCS"}, {"code": "CR-FL-25MG", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECTABLE K30003010 AUGMENT 3CC K30003010", "code_information": [{"code": "C1734", "type": "HCPCS"}, {"code": "K30003010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8632.0, "discounted_cash": 5179.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECTION ABDOMINAL SHUNT", "code_information": [{"code": "49427", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF 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"standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION DIAGNOSTIC/THERAPEUTIC AGENT CERVICAL/THORACIC 3RD LEVEL 64492", "code_information": [{"code": "64492", "type": "CPT"}, {"code": "1582409", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 640.2, "maximum": 8427.0, "gross_charge": 1164.0, "discounted_cash": 698.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 640.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION DIAGNOSTIC/THERAPEUTIC AGENT PARAVERTEBRAL FACET JOINT W/ IMAGE CERVICAL/THORACIC 64491", "code_information": [{"code": "64491", "type": "CPT"}, {"code": "1582408", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 640.2, "maximum": 8427.0, "gross_charge": 1164.0, "discounted_cash": 698.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 640.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION EXT VENOGRAPHY", "code_information": [{"code": "36005", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR BLADDER X-RAY", "code_information": [{"code": "51600", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", 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3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR CHOLANGIOGRAM", "code_information": [{"code": "47531", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee 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"code_information": [{"code": "47532", "type": "CPT"}], "standard_charges": [{"minimum": 3869.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR HIP ARTHROGRAPHY W/ANESTHESIA 27095", "code_information": [{"code": "27095", "type": "CPT"}, {"code": "1481118", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 246.95, "maximum": 8427.0, "gross_charge": 449.0, "discounted_cash": 269.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR HIP ARTHROGRAPHY W/O ANESTHESIA 27093", "code_information": [{"code": "27093", "type": "CPT"}, {"code": "1481119", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 246.95, "maximum": 8427.0, "gross_charge": 449.0, "discounted_cash": 269.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 246.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SALIVARY X-RAY", "code_information": [{"code": "42550", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SHOULDER ARTHROGRAPHY 23350", "code_information": [{"code": "23350", "type": "CPT"}, {"code": "1481121", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 246.95, "maximum": 8427.0, "gross_charge": 449.0, "discounted_cash": 269.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 246.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SPLEEN X-RAY", "code_information": [{"code": "38200", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR TEAR SAC X-RAY", "code_information": [{"code": "68850", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR URETER X-RAY", "code_information": [{"code": "50684", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR URETER X-RAY", "code_information": [{"code": "50690", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", 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"discounted_cash": 153.58, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECTION NEEDLES Injection Needle Lower 129-0170 22/5 2.3 230 2.8", "code_information": [{"code": "IN33151", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.66, "discounted_cash": 59.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECTION NEEDLES Injection Needle Lower 129-0172 25/5 2.3 230 2.8", "code_information": [{"code": "IN33241", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.66, "discounted_cash": 59.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECTION NEEDLES Injection Needle Upper 129-0169 22/5 2.3 180 2.8", "code_information": [{"code": "IN33131", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.66, "discounted_cash": 59.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECTION NEEDLES 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION PLATELET RICH PLASMA INC IMAGE HARVEST/PREP 0232T", "code_information": [{"code": "232T", "type": "CPT"}, {"code": "1764940", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 4173.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TRIGGER POINT SINGLE 20552", "code_information": [{"code": "20552", "type": "CPT"}, {"code": "1481134", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, CEFOPERAZONE SOD", "code_information": [{"code": "S0021", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, CEFOTETAN DISODIU", "code_information": [{"code": "S0074", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, CIMETIDINE HYDROC", "code_information": [{"code": "S0023", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, FAMOTIDINE, 20 MG", "code_information": [{"code": "S0028", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, FOSPHENYTOIN SODI", "code_information": [{"code": "S0078", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, NAFCILLIN SODIUM", "code_information": [{"code": "S0032", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, OFLOXACIN, 400 MG", "code_information": [{"code": "S0034", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, PENTAMIDINE ISETH", "code_information": [{"code": "S0080", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, PIPERACILLIN SODI", "code_information": [{"code": "S0081", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, SULFAMETHOXAZOLE", "code_information": [{"code": "S0039", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, TICARCILLIN DISOD", "code_information": [{"code": "S0040", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE;EPIDURAL CERVICAL OR THORACIC 62281", "code_information": [{"code": "62281", "type": "CPT"}, {"code": "1481137", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE;EPIDURAL LUMBAR SACRAL 62282", "code_information": [{"code": "62282", "type": "CPT"}, {"code": "1481138", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE;SUBARACHNOID 62280", "code_information": [{"code": "62280", "type": "CPT"}, {"code": "1481139", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 3RD", "code_information": [{"code": "36247", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART ADDL", "code_information": [{"code": "36248", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST BILAT", "code_information": [{"code": "36252", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST UNILAT", "code_information": [{"code": "36251", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 2ND+ BILAT", "code_information": [{"code": "36254", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 2ND+ UNILAT", "code_information": [{"code": "36253", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS DEVICE FOR RT GUIDE OPEN", "code_information": [{"code": "49412", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee 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"plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS ENDOVAS VENA CAVA FILTR", "code_information": [{"code": "37191", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", 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billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS MARK THOR FOR RT PERQ", "code_information": [{"code": "32553", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS SK-MNT CRNL NSTM PG/RCVR", "code_information": [{"code": "61889", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS VAG BRACHYTX DEVICE", "code_information": [{"code": "57156", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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ANT. SEG. DRAINAGE DEVICE TRAB. MESH W/O EXT. RES. CAT ONE OR MORE 0671T", "code_information": [{"code": "671T", "type": "CPT"}, {"code": "46125796", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1150.6, "maximum": 10329.0, "gross_charge": 2092.0, "discounted_cash": 1255.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1150.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS/REP SUBQ DEFIBRILLATOR", "code_information": [{"code": "33270", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 63075.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 36437.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 63075.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56768.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS/RPLCMT PRQ ELTRD RA PN 1", "code_information": [{"code": "64596", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS/RPLMT ELTRD RA SPI NSTIM", "code_information": [{"code": "784T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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UHMWPE IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1006-0-3254", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3199.42, "discounted_cash": 1919.65, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT ACET 32MM X 54MM ACTBLR CUP SYS BIOLOGICAL FXTN HIGHLY CROSS LINKED UHMWP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1007-0-3254", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT ACET 36MM X 56MM 10 HOOD ACTBLR CUP SYS HIGHLY CROSS LINKED UHMWPE IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1008-0-3656", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4940.0, "discounted_cash": 2964.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT ACET 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"standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6688.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6336.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"facility"}]}, {"description": "INSERT BRAIN-FLUID DEVICE", "code_information": [{"code": "61215", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT CANNULA 2000001 INSERTER 7MM 2000001", "code_information": [{"code": "2000001", "type": "CDM"}], "standard_charges": [{"gross_charge": 233.21, "discounted_cash": 139.93, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CANNULA 2000002 INSERTER 9MM 2000002", "code_information": [{"code": "2000002", "type": "CDM"}], "standard_charges": [{"gross_charge": 233.21, "discounted_cash": 139.93, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CANNULA 2000003 INSERTER 11MM 2000003", "code_information": [{"code": "2000003", "type": "CDM"}], "standard_charges": [{"gross_charge": 233.21, "discounted_cash": 139.93, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CAP 2570020 LOOP INSERTER IMPACTOR CAP 2570020", "code_information": [{"code": "2570020", "type": "CDM"}], "standard_charges": [{"gross_charge": 426.6, "discounted_cash": 255.96, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CAP 2670015 WAVE IMPACTOR INSERTER CAP 2670015", "code_information": [{"code": "2670015", "type": "CDM"}], "standard_charges": [{"gross_charge": 452.2, "discounted_cash": 271.32, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CARD ELECTRODES DUAL", "code_information": [{"code": "33211", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO 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schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT CATH PLEURA W/O IMAGE", "code_information": [{"code": "32556", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 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"standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT CERVICAL DILATOR", "code_information": [{"code": "59200", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT COMPONENT SIZE 3.0 RT POST STAB PERI APATITE CEMENTLESS BEADED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5516-F-302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10441.86, "discounted_cash": 6265.12, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CONFORMIS 8MM POLY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TPS-111-1111-8I", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5525.0, "discounted_cash": 3315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CONNECTOR INSERTER 6067.6", "code_information": [{"code": "6067.6", "type": "CDM"}], "standard_charges": [{"gross_charge": 2851.2, "discounted_cash": 1710.72, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CONSTRAINED 44MM POLYETHYLENE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "69-2244", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7007.0, "discounted_cash": 4204.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CROSS CONNECTOR INSERTER 6067.1055", "code_information": [{"code": "6067.1055", "type": "CDM"}], "standard_charges": [{"gross_charge": 1866.24, "discounted_cash": 1119.74, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CROSSLINK POLY ARTICULAR SUFACE MEDIAL LEFT 8-9MM 42-5121-005-12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5121-005-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1575.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CRS REVISION ROTATING PLATFORM SZ6 16MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1517-10-616", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3484.0, "discounted_cash": 2090.4, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CS TRIATHLON X3 SZ 8 11MM TIBIAL BEARING  5531-G-811-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-811-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CS2 ACET CUP SYSTEM VITALITE 20DEG HOOD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1723-0-3250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4288.15, "discounted_cash": 2572.89, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CURVED BONE GRAFT INSERTER 394.58", "code_information": [{"code": "394.58", "type": "CDM"}], "standard_charges": [{"gross_charge": 561.26, "discounted_cash": 336.76, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CUSHION FOR USE W/ PRONEVIEW PROTECTIVE HELMET SYS PRONEVIEW", "code_information": [{"code": "D28503", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 62.4, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CUSHION STANDARD PRONEVIEW", "code_information": [{"code": "D28503CE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 62.4, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CV CATH INF & SUP APP", "code_information": [{"code": "C9780", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT DRIVER 5484337 NON-BRKOFF PROVSNL INSERT 5484337", "code_information": [{"code": "5484337", "type": "CDM"}], "standard_charges": [{"gross_charge": 588.47, "discounted_cash": 353.08, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT DRIVER 5584002 NON-BRKOFF PROVSNL INSERT 5584002", "code_information": [{"code": "5584002", "type": "CDM"}], "standard_charges": [{"gross_charge": 553.39, "discounted_cash": 332.03, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT DRUG DEL IMPLANT, >=4", "code_information": [{"code": "G0516", "type": "HCPCS"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ELECTRD/PM CATH SNGL", "code_information": [{"code": "33210", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ELECTRODES FOR EEG", "code_information": [{"code": "95830", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT EMERGENCY AIRWAY", "code_information": [{"code": "31500", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ENDOVASC PROSTH TAA", "code_information": [{"code": "33883", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT EPICARD ELTRD ENDO", "code_information": [{"code": "33203", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT EPICARD ELTRD OPEN", "code_information": [{"code": "33202", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT EVERLAST INFINITY SIZE2 8MM 33682208", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "33682208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3118.7, "discounted_cash": 1871.22, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT FEMORAL SZ 3 LFT CRUCIATE RETAINING NP LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71423203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7208.5, "discounted_cash": 4325.1, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT FLEX SHOULDER SYSTEM REVERSED DWF391C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF391C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1747.5, "discounted_cash": 1048.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT FUSE PLIF INSERTER SHAFT FPI-001B", "code_information": [{"code": "FPI-001B", "type": "CDM"}], "standard_charges": [{"gross_charge": 798.0, "discounted_cash": 478.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT FUSE PLIF INSERTER TUBE FPI-002A", "code_information": [{"code": "FPI-002A", "type": "CDM"}], "standard_charges": [{"gross_charge": 2592.0, "discounted_cash": 1555.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT G7 LONGEVITY NEUTRAL 36MM G 20103607", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "20103607", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1125.0, "discounted_cash": 675.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HANDLE 6973000 INSERTER HANDLE US 6973000", "code_information": [{"code": "6973000", "type": "CDM"}], "standard_charges": [{"gross_charge": 1111.61, "discounted_cash": 666.97, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HAT TRICK 2.7 X 4 MM 10 DEG PIP FUSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72204370", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1407.0, "discounted_cash": 844.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HEART PM ATRIAL", "code_information": [{"code": "33206", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding 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{"description": "INSERT INSERTER 2942001 DL INSERTER 2942001", "code_information": [{"code": "2942001", "type": "CDM"}], "standard_charges": [{"gross_charge": 3402.0, "discounted_cash": 2041.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT INSERTER 2982001 THREADED 2982001", "code_information": [{"code": "2982001", "type": "CDM"}], "standard_charges": [{"gross_charge": 1043.65, "discounted_cash": 626.19, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT INSERTER 2990001 THREADED 2990001", "code_information": [{"code": "2990001", "type": "CDM"}], "standard_charges": [{"gross_charge": 981.94, "discounted_cash": 589.16, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT INSERTER 3990001 LONG GRASPING 3990001", "code_information": [{"code": "3990001", "type": "CDM"}], "standard_charges": [{"gross_charge": 1077.3, "discounted_cash": 646.38, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT 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{"description": "INSERT INSERTER 7730815 MP FREEHND INSRTR PLT 7730815", "code_information": [{"code": "7730815", "type": "CDM"}], "standard_charges": [{"gross_charge": 396.9, "discounted_cash": 238.14, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT INSERTER 7730816 MP FREEHND INSRTR IB 7730816", "code_information": [{"code": "7730816", "type": "CDM"}], "standard_charges": [{"gross_charge": 396.9, "discounted_cash": 238.14, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT INSERTER 7967011 MARKER 7967011", "code_information": [{"code": "7967011", "type": "CDM"}], "standard_charges": [{"gross_charge": 196.24, "discounted_cash": 117.74, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT INSERTER 7967012 CP 7967012", "code_information": [{"code": "7967012", "type": "CDM"}], "standard_charges": [{"gross_charge": 898.95, "discounted_cash": 539.37, "setting": "both", "billing_class": "facility"}]}, {"description": 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688.35", "code_information": [{"code": "688.35", "type": "CDM"}], "standard_charges": [{"gross_charge": 6454.08, "discounted_cash": 3872.45, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT LATERAL BARREL INSERTER  44-55MM 688.351", "code_information": [{"code": "688.351", "type": "CDM"}], "standard_charges": [{"gross_charge": 6613.92, "discounted_cash": 3968.35, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT LATERAL INSERTER 693.601", "code_information": [{"code": "693.601", "type": "CDM"}], "standard_charges": [{"gross_charge": 2034.72, "discounted_cash": 1220.83, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT LCS COMPLETE TIBIAL INSERT ROTATING PLATFORM LCS RPS 17.5MM LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1294-16-617", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4147.0, "discounted_cash": 2488.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT LEVONORGESTREL IUS", "code_information": [{"code": "S4981", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT LOOP INSERTER SHAFT MI-002D", "code_information": [{"code": "MI-002D", "type": "CDM"}], "standard_charges": [{"gross_charge": 1166.4, "discounted_cash": 699.84, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT LOOP INSERTER TUBE MI-001E", "code_information": [{"code": "MI-001E", "type": "CDM"}], "standard_charges": [{"gross_charge": 426.6, "discounted_cash": 255.96, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT LOOP INSERTER TUBE MI-001F", "code_information": [{"code": "MI-001F", "type": "CDM"}], "standard_charges": [{"gross_charge": 518.7, "discounted_cash": 311.22, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT MAJOR VESSEL GRAFT", "code_information": [{"code": "33330", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT MAJOR VESSEL GRAFT", "code_information": [{"code": "33335", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT MINI PEEK RING /CONE INSERTER ASSEMBLY VAR-032-24", "code_information": [{"code": "VAR-032-24", "type": "CDM"}], "standard_charges": [{"gross_charge": 180.12, "discounted_cash": 108.07, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT MODULAR 2.5MM OFFSET 3.6MM THICK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "9P15-PB01-W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2268.0, "discounted_cash": 1360.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT MP1 SURGICAL  3610001", "code_information": [{"code": "3610001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1488.24, "discounted_cash": 892.94, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT MT1520  TIP 3600021", "code_information": [{"code": "3600021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1985.04, "discounted_cash": 1191.02, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT NEEDLE BONE CAVITY", "code_information": [{"code": "36680", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT NON-TUNNEL CV CATH", "code_information": [{"code": "36555", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT OCULAR IMPLANT", "code_information": [{"code": "65135", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ONLAY TIBIAL X3 SIZE 3 9MM THICK 180733-2-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "180733-2-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT ORACLE LATERAL QUICK INSERTER/DISTRACTOR 03.809.921", "code_information": [{"code": "3.809.921", "type": "CDM"}], "standard_charges": [{"gross_charge": 28350.0, "discounted_cash": 17010.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PACING LEAD & CONNECT", "code_information": [{"code": "33224", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 23180.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 13391.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 23180.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ6 14MM FIXED BEARING POST STABILIZED IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1516-50-614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ6 7MM FIXED BEARING POST STABILIZED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1516-50-607", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ7 10MM FIXED BEARING POST STABILIZED IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1516-50-710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2600.0, "discounted_cash": 1560.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ7 12MM FIXED BEARING POST STABILIZED IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1516-50-712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ7 16MM FIXED BEARING POST STABILIZED IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1516-50-716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ8 10MM FIXED BEARING POST STABILIZED IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1516-50-810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ8 12MM FIXED BEARING POST STABILIZED IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1516-50-812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ8 14MM FIXED BEARING POST STABILIZED IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1516-50-814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ8 18MM FIXED BEARING POST STABILIZED IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1516-50-818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ8 7MM FIXED BEARING POST STABILIZED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1516-50-807", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBL SZ8 8MM FIXED BEARING POST STABILIZED IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1516-50-808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TISSUE EXPANDER(S)", "code_information": [{"code": "11960", "type": "CPT"}], "standard_charges": [{"minimum": 3303.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TRAY 1664016 CDH 4.75 PERC INSERTER 1664016", "code_information": [{"code": "1664016", "type": "CDM"}], "standard_charges": [{"gross_charge": 595.02, "discounted_cash": 357.01, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TREPHINE INSERTER 387.638", "code_information": [{"code": "387.638", "type": "CDM"}], "standard_charges": [{"gross_charge": 1814.4, "discounted_cash": 1088.64, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TRIATHLON SZ 3 9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-309", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4987.84, "discounted_cash": 2992.7, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TRIATHLON TIBIAL BEARING PS SZ 5 PS 16MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-p-516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3463.46, "discounted_cash": 2078.08, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TRIATHLON X3 TIBIAL BEARING INSERT PS SZE 4 THKNS 9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-409-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TUN IP CATH PERC", "code_information": [{"code": "49418", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUN IP CATH W/PORT", "code_information": [{"code": "49419", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36557", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36558", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36560", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36565", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 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"UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION NASAL SEPTAL PROSTHESIS 30220", "code_information": [{"code": "30220", "type": "CPT"}, {"code": "23179561", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1061.5, "maximum": 8427.0, "gross_charge": 1930.0, "discounted_cash": 1158.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF ANT. SEG. AQUEOUS DRAINAGE DEVICE; WITHOUT EXTRAOCULAR RESERVOIR; EXT. APPROACH 66183", "code_information": [{"code": "66183", "type": "CPT"}, {"code": "18370605", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 10329.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEV. W/O EXTRAOCULAR RESERVOIR; EA. ADD DEVICE 0376T", "code_information": [{"code": "376T", "type": "CPT"}, {"code": "45355485", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36800", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36810", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36815", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA(S)", "code_information": [{"code": "36823", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36481", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36500", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36510", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CHEST TUBE", "code_information": [{"code": "32551", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": 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"plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF INFUSION PUMP", "code_information": [{"code": "36260", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF INTERVERTEBRAL BIOMECHANICAL DEVICE; W/O INTERBODY EA/CONTIGUOUS DEFECT 22859", "code_information": [{"code": "22859", "type": "CPT"}, {"code": "44660440", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 18989.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF INTRAUTERINE DEVICE 58300", "code_information": [{"code": "58300", "type": "CPT"}, {"code": "1587160", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 449.0, "discounted_cash": 269.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 246.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF IRIS PROSTHESIS", "code_information": [{"code": "616T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 9391.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 9391.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7982.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF LEFT HEART VENT", "code_information": [{"code": "33988", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF MULTI-COMPONENT INFLATABLE PENILE PROSTHESIS 54405", "code_information": [{"code": "54405", "type": "CPT"}, {"code": "1481149", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 23180.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", 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2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, 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"plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTOR CINCHLOCK KNOTLESS ANCHOR SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CAT02462", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1312.2, "discounted_cash": 787.32, "setting": "both", "billing_class": "facility"}]}, {"description": "INSET ART SURFACE BEARING FIXED 10MM RIGHT RIGHT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42522000610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8060.0, "discounted_cash": 4836.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSITU HYBRIDIZATION (FISH)", "code_information": [{"code": "88366", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 53.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 108.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 108.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 113.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 102.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 76.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 645.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 549.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ AQUEOUS DRAIN DEV EACH", "code_information": [{"code": "450T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 4173.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ AQUEOUS DRG DEV IO RSVR", "code_information": [{"code": "474T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ BIOPROSTC VLV FEM VN", "code_information": [{"code": "744T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ GTUBE PERQ MAG GASTRPXY", "code_information": [{"code": "647T", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ IMPLTBL GLUCOSE SENSOR", "code_information": [{"code": "446T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 4173.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ IRIS PROSTH SEC IO LENS", "code_information": [{"code": "618T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 9391.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 9391.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7982.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ IRIS PROSTH W/RMVL&INSJ", "code_information": [{"code": "617T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 9391.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 9391.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7982.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ OCULAR TELESCOPE PROSTH", "code_information": [{"code": "308T", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 37880.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 37880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34092.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD L HRT ARTERIAL", "code_information": [{"code": "33990", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD L HRT ARTL&VEN", "code_information": [{"code": "33991", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD R HRT VENOUS", "code_information": [{"code": "33995", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PHRNC NRV STIM SYS", "code_information": [{"code": "33276", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 63075.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 63075.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56768.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PHRNC NRV STIM TRANSVNS", "code_information": [{"code": "33277", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PICC <5 YR W/O IMAGING", "code_information": [{"code": "36568", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PICC RS&I <5 YR", "code_information": [{"code": "36572", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ RX ELUT IMPLT LAC CANAL", "code_information": [{"code": "68841", "type": "CPT"}], "standard_charges": [{"minimum": 3004.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ SINUS TARSI IMPLANT", "code_information": [{"code": "335T", "type": "CPT"}], "standard_charges": [{"minimum": 3866.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/DCMPRN", "code_information": [{"code": "22868", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/O DCMPRN", "code_information": [{"code": "22869", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/O DCMPRN", "code_information": [{"code": "22870", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ SUBQ CAR RHYTHM MNTR", "code_information": [{"code": "33285", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ SUBQ IMPLTBL DFB ELCTRD", "code_information": [{"code": "33271", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV BOTH COMPNT PG", "code_information": [{"code": "517T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV COMPL SYS", "code_information": [{"code": "515T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 63075.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 63075.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56768.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV ELTRD ONLY", "code_information": [{"code": "516T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ ATR ELT", "code_information": [{"code": "410T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ PLS GN", "code_information": [{"code": "409T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 63075.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 63075.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56768.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ VNT ELT", "code_information": [{"code": "411T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CARDIAC MODULJ SYS", "code_information": [{"code": "408T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 63075.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 63075.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56768.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT COMPL IIMS", "code_information": [{"code": "525T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT DEFIB W/LEAD(S)", "code_information": [{"code": "33249", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 63075.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 36437.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 63075.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56768.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT ICDS SS ELTRD", "code_information": [{"code": "571T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 63075.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 63075.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56768.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT IIMS ELTRD ONLY", "code_information": [{"code": "526T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT IIMS IMPLT MNTR", "code_information": [{"code": "527T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT PG ONLY ISDSS", "code_information": [{"code": "680T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT PRQ RA SAC NSTIM", "code_information": [{"code": "786T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSPACE US MEDIUM 0131", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "131", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13600.0, "discounted_cash": 8160.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSPIRA AIR BALLOON DILAT", "code_information": [{"code": "BC1240A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1501.2, "discounted_cash": 900.72, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT A & V PM W/L VENT LEAD", "code_information": [{"code": "C7539", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT ATRIL PM W/L VENT LEAD", "code_information": [{"code": "C7537", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER 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"standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 36437.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 63075.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56768.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", 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"plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 36437.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 63075.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 63075.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56768.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT VENT PM W/L VENT LEAD", "code_information": [{"code": "C7538", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INST ARTHROSCOPIC ENERGY 90DEG PROBE WITH SUCTION", "code_information": [{"code": "AES-905", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 465.5, "discounted_cash": 279.3, "setting": "both", "billing_class": "facility"}]}, {"description": "INST DILATORS SAFE OP AIX1330-S", "code_information": [{"code": "AIX1330-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2430.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INST DISP ACL RECON FEM-TIB GUIDE STRL", "code_information": [{"code": "234-030-010R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INST KIT  9735263 TAP SOLERA NONCAN 4.5 9735263", "code_information": [{"code": "9735263", "type": "CDM"}], "standard_charges": [{"gross_charge": 2357.94, "discounted_cash": 1414.76, "setting": "both", "billing_class": "facility"}]}, {"description": "INST KIT 9735264 TAP SOLERA NONCAN 5.0 9735264", "code_information": [{"code": "9735264", "type": "CDM"}], "standard_charges": [{"gross_charge": 2357.94, "discounted_cash": 1414.76, "setting": "both", "billing_class": "facility"}]}, {"description": "INST KIT 9735265 TAP SOLERA NONCAN 5.5 9735265", "code_information": [{"code": "9735265", "type": "CDM"}], "standard_charges": [{"gross_charge": 2357.94, "discounted_cash": 1414.76, "setting": "both", 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{"description": "INSULIN TOLERANCE PANEL", "code_information": [{"code": "80434", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 828.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1664.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1664.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1751.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1576.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1173.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 834.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 709.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN TOLERANCE PANEL", "code_information": [{"code": "80435", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 843.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1694.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1694.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INT HRHC LIG 2+HROID W/O IMG", "code_information": [{"code": "46946", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INT HRHC TRANAL DARTLZJ 2+", "code_information": [{"code": "46948", "type": "CPT"}], "standard_charges": [{"minimum": 3866.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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{"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7605.0, "discounted_cash": 4563.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY CASCADIA 8.5MM X 28MM X 11MM AN CONVEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2852811NC-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10400.0, "discounted_cash": 6240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY CASCADIA SYSTEM 12MM X 60MM X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2226012LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11050.0, "discounted_cash": 6630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY CERVICAL HYBRID 8MM SMALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2000-1412-08L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2520.0, "discounted_cash": 1512.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY CERVICAL SMALL 7MM HYBRID", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2000-1412-07L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2520.0, "discounted_cash": 1512.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY CONVEX SIZE 8.5X28X8 MM AN  6101-2852808NC-G2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2852808NC-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7605.0, "discounted_cash": 4563.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY F3D ALIF  30MM X 45MM  15DEG  13MM 3AF3045-1513", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF3045-1513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6500.0, "discounted_cash": 3900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY F3D ALIF 25MM X 35MM 15DEG 3AF2535-1512", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2535-1512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5720.0, "discounted_cash": 3432.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY F3D ALIF 25MM X 35MM X 15MM 15DEG 3AF2535-1515", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2535-1515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6500.0, "discounted_cash": 3900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY F3D ALIF 27MM X 40MM 15DEG 3AF2740-1518", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2740-1518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5720.0, "discounted_cash": 3432.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY F3D ALIF 3AF2740-1513", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3AF2740-1513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6500.0, "discounted_cash": 3900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY FUSION DEVICE STRAIGHT 9X22 6DEG 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PSTS-SM0610-22-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10400.0, "discounted_cash": 6240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY LAT 14MM X 60MM X 22MM TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2226014LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11050.0, "discounted_cash": 6630.0, "setting": 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"billing_class": "facility"}]}, {"description": "INTERBODY SYSTEM CASCADIA 12MM X 50MM X 22MM 8DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2225012LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11050.0, "discounted_cash": 6630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY SYSTEM CASCADIA 12MM X 55MM X 22MM X 0DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2225512LP-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11050.0, "discounted_cash": 6630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY SYSTEM CASCADIA 22MM X 55MM X 12MM 8DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2225512LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11700.0, "discounted_cash": 7020.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY SYSTEM CASCADIA 22MM X 60MM X 10MM 8DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2226010LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11700.0, "discounted_cash": 7020.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY SYSTEM CERVICAL CASCADIA 9MM X 16MM X 13MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2131609CL7-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2912.0, "discounted_cash": 1747.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY SYSTEM LATERAL 10X55X18MM 0DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2185510LP-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11050.0, "discounted_cash": 6630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY SYSTEM LATERAL CASCADIA 18X45X12MM 8DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2184512LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11050.0, "discounted_cash": 6630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY SYSTEM LATERAL CASCADIA 18X50X12MM 8DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6101-2185012LL8-G2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11050.0, "discounted_cash": 6630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODYANTERIOR FUSION DEVICE 27X35X12 L15 03.31.027", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3.31.027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7800.0, "discounted_cash": 4680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERCALARY ALGRFT COMPL", "code_information": [{"code": "20934", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": 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"code_information": [{"code": "687.035", "type": "CDM"}], "standard_charges": [{"gross_charge": 3235.68, "discounted_cash": 1941.41, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERCONTINENTAL DTS GUIDE  17MM 687.037", "code_information": [{"code": "687.037", "type": "CDM"}], "standard_charges": [{"gross_charge": 3235.68, "discounted_cash": 1941.41, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERCONTINENTAL DTS GUIDE  8MM 687.028", "code_information": [{"code": "687.028", "type": "CDM"}], "standard_charges": [{"gross_charge": 3235.68, "discounted_cash": 1941.41, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERCONTINENTAL DTS GUIDE  9MM 687.029", "code_information": [{"code": "687.029", "type": "CDM"}], "standard_charges": [{"gross_charge": 3235.68, "discounted_cash": 1941.41, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERCONTINENTAL DTS HOLDER HEX DRIVER 687.02", "code_information": [{"code": "687.02", "type": "CDM"}], "standard_charges": [{"gross_charge": 1101.6, "discounted_cash": 660.96, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERCONTINENTAL SHORT 3.5MM HEX DRIVER TIP 687.026", "code_information": [{"code": "687.026", "type": "CDM"}], "standard_charges": [{"gross_charge": 395.0, "discounted_cash": 237.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERCONTINENTAL SHORT 5.5 TAP TIP 687.721", "code_information": [{"code": "687.721", "type": "CDM"}], "standard_charges": [{"gross_charge": 464.52, "discounted_cash": 278.71, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERCONTINENTAL STRAIGHT SHAFT 3.5MM HEX DRIVER 687.527", "code_information": [{"code": "687.527", "type": "CDM"}], "standard_charges": [{"gross_charge": 1129.68, "discounted_cash": 677.81, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERCONTINENTAL STRAIGHT SHAFT 5.5MM TAP 687.526", "code_information": [{"code": "687.526", "type": "CDM"}], "standard_charges": [{"gross_charge": 1129.68, "discounted_cash": 677.81, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERCONTINENTAL STRAIGNT SHAFT AWL 687.524", "code_information": [{"code": "687.524", "type": "CDM"}], "standard_charges": [{"gross_charge": 1129.68, "discounted_cash": 677.81, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERDENTAL WIRING", "code_information": [{"code": "21497", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERDISCAL PERQ ASPIR DX", "code_information": [{"code": "62267", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERFUSE S SINGLE 10MM X 20MM 5 ANGLE SPINE CODE 25", "code_information": [{"code": "9076-10-20-5-B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18360.0, "discounted_cash": 11016.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERFUSE S SPINE 12MM X 20MM 5ANGL SINGLE", "code_information": [{"code": "9076-12-20-5-B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18360.0, "discounted_cash": 11016.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERLINK EXT SET W CONTROL-A-FLO 2C6891", "code_information": [{"code": "2C6891", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.18, "discounted_cash": 18.11, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERLOCK II TI-C 9X17X14MM 15", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6770915CP2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6500.0, "discounted_cash": 3900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERMEDIATE VISUAL FIELD XM", "code_information": [{"code": "92082", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERNAL BRACE LIGAMENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1688-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3993.6, "discounted_cash": 2396.16, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERNAL COUNTER TORQUE FOR ASSEMBLED VAS 388.264", "code_information": [{"code": "388.264", "type": "CDM"}], "standard_charges": [{"gross_charge": 978.88, "discounted_cash": 587.33, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERNAL COUNTERTORQUE WITH T-HANDLE 388.143", "code_information": [{"code": "388.143", "type": "CDM"}], "standard_charges": [{"gross_charge": 3402.0, "discounted_cash": 2041.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERNAL NEUROLYSIS REQUIRING USE OF OPERATING MICROSCOPE 64727", "code_information": [{"code": "64727", "type": "CPT"}, {"code": "1792998", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL ICPMS IP", "code_information": [{"code": "93290", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL IIMS IP", "code_information": [{"code": "529T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL SCRMS IP", "code_information": [{"code": "93291", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL WCS IP", "code_information": [{"code": "521T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROG DEVICE EVAL HEART", "code_information": [{"code": "93289", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG EVL PM/LDLS PM IP", "code_information": [{"code": "93288", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG W/O PRGRMG IPNSS", "code_information": [{"code": "93153", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG&PRGRMG IPNSS", "code_information": [{"code": "93151", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG&PRGRMG IPNSS POLYSM", "code_information": [{"code": "93152", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROGATE SUBQ DEFIB", "code_information": [{"code": "93261", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee 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CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERSTIM MRI LEAD KIT 28CM 978A128", "code_information": [{"code": "C1897", "type": "HCPCS"}, {"code": "978A128", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9373.0, "discounted_cash": 5623.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERSTIM PERCUTANEOUS EXTENTION 3560022", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "3560022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERSTIM RECHARGER KIT RS5200", "code_information": [{"code": "RS5200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2916.0, "discounted_cash": 1749.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITH CC", "code_information": [{"code": "197", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7352.48, "maximum": 11228.58, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11228.58, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7352.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITH MCC", "code_information": [{"code": "196", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12023.65, "maximum": 21369.46, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 21369.46, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12023.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC", "code_information": [{"code": "198", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5567.39, "maximum": 7633.17, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7633.17, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5567.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL RADIATION SOURCE APPLICATION COMPLEX 77778", "code_information": [{"code": "77778", "type": "CPT"}, {"code": "1700105", "type": "CDM"}, {"code": "342", "type": "RC"}], "standard_charges": [{"minimum": 2685.2, "maximum": 10475.47, "gross_charge": 6289.0, "discounted_cash": 3773.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 3458.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 2955.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 3144.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 3270.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4954.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9951.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9951.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10475.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9427.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 7018.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3159.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2685.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERTHORACOSCPLR AMPUTATION", "code_information": [{"code": "23900", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERVERTEBRAL DISC EXCISOR 11MM 389.782", "code_information": [{"code": "389.782", "type": "CDM"}], "standard_charges": [{"gross_charge": 2533.68, "discounted_cash": 1520.21, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERVERTEBRAL DISC EXCISOR 13MM 389.783", "code_information": [{"code": "389.783", "type": "CDM"}], "standard_charges": [{"gross_charge": 2533.68, "discounted_cash": 1520.21, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERVERTEBRAL DISC EXCISOR 15MM 389.784", "code_information": [{"code": "389.784", "type": "CDM"}], "standard_charges": [{"gross_charge": 2533.68, "discounted_cash": 1520.21, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERVERTEBRAL DISC EXCISOR 17MM 389.785", "code_information": [{"code": "389.785", "type": "CDM"}], "standard_charges": [{"gross_charge": 2533.68, "discounted_cash": 1520.21, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERVERTEBRAL DISC EXCISOR 9MM 389.781", "code_information": [{"code": "389.781", "type": "CDM"}], "standard_charges": [{"gross_charge": 2533.68, "discounted_cash": 1520.21, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERVERTEBRAL DISC SHAVER 11MM 389.771", "code_information": [{"code": "389.771", "type": "CDM"}], "standard_charges": [{"gross_charge": 2442.96, "discounted_cash": 1465.78, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERVERTEBRAL DISC SHAVER 12MM 389.772", "code_information": [{"code": "389.772", "type": "CDM"}], "standard_charges": [{"gross_charge": 2442.96, "discounted_cash": 1465.78, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERVERTEBRAL DISC SHAVER 13MM 389.773", "code_information": [{"code": "389.773", "type": "CDM"}], "standard_charges": [{"gross_charge": 2442.96, "discounted_cash": 1465.78, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERVERTEBRAL DISC SHAVER 15MM 389.775", "code_information": [{"code": "389.775", "type": "CDM"}], "standard_charges": [{"gross_charge": 2442.96, "discounted_cash": 1465.78, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERVERTEBRAL DISC SHAVER 17MM 389.777", "code_information": [{"code": "389.777", "type": "CDM"}], "standard_charges": [{"gross_charge": 2442.96, "discounted_cash": 1465.78, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERVERTEBRAL DISC SHAVER 7MM 389.767", "code_information": [{"code": "389.767", "type": "CDM"}], "standard_charges": [{"gross_charge": 2442.96, "discounted_cash": 1465.78, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERVERTEBRAL DISC SHAVER 8MM 389.768", "code_information": [{"code": "389.768", "type": "CDM"}], "standard_charges": [{"gross_charge": 2442.96, "discounted_cash": 1465.78, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERVERTEBRAL DISC SHAVER 9MM 389.769", "code_information": [{"code": "389.769", "type": "CDM"}], "standard_charges": [{"gross_charge": 2442.96, "discounted_cash": 1465.78, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERVERTEBRAL RING CURETTE ANGLED/11MM WIDTH 389.57", "code_information": [{"code": "389.57", "type": "CDM"}], "standard_charges": [{"gross_charge": 2023.92, "discounted_cash": 1214.35, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERVERTEBRAL RING CURETTE ANGLED/8MM WIDTH 389.58", "code_information": [{"code": "389.58", "type": "CDM"}], "standard_charges": [{"gross_charge": 2023.92, "discounted_cash": 1214.35, "setting": "both", "billing_class": "facility"}]}, {"description": "INTESTINAL STRICTUROPLASTY", "code_information": [{"code": "44615", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTESTINE TRANSPLANT LIVE", "code_information": [{"code": "44136", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTESTINE TRANSPLNT CADAVER", "code_information": [{"code": "44135", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 12.6-20 CM", "code_information": [{"code": "12055", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 20.1-30.0", "code_information": [{"code": "12056", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 7.6-12.5CM", "code_information": [{"code": "12054", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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"plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM >30.0 CM", "code_information": [{"code": "12057", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT20.1-30", "code_information": [{"code": "12046", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/A/T/EXT 20.1-30", "code_information": [{"code": "12036", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRA-ATRIAL PACING", "code_information": [{"code": "93610", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRA-ATRIAL RECORDING", "code_information": [{"code": "93602", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 15456.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee 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"billing_class": "facility"}]}, {"description": "INTRACAPSULAR CATARACT EXTRACTION WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS 66983", "code_information": [{"code": "66983", "type": "CPT"}, {"code": "1481163", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 9391.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3330.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4892.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6688.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6336.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4717.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRAN ANGIOPLSTY W/STENT", "code_information": [{"code": "61635", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": 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"UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL ANGIOPLASTY", "code_information": [{"code": "61630", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee 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for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1022.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 868.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS", "code_information": [{"code": "65", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7571.21, "maximum": 11533.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11533.68, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7571.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC", "code_information": [{"code": "64", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13719.93, "maximum": 22561.51, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 22561.51, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13719.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC", "code_information": [{"code": "66", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5334.71, "maximum": 7806.7, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7806.7, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5334.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL LIMITED STUDY", "code_information": [{"code": "93888", "type": "CPT"}], "standard_charges": [{"minimum": 397.64, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC", "code_information": [{"code": "21", "type": "MS-DRG"}], "standard_charges": [{"minimum": 58027.1, "maximum": 60576.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 60576.49, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 58027.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC", "code_information": [{"code": "20", "type": "MS-DRG"}], "standard_charges": [{"minimum": 76521.7, "maximum": 91429.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 91429.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 76521.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC", "code_information": [{"code": "22", "type": "MS-DRG"}], "standard_charges": [{"minimum": 31326.6, "maximum": 37856.05, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 31326.6, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 37856.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61680", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61682", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61684", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61686", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61690", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61692", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAGASTRIC HYPOTHERMIA", "code_information": [{"code": "M0100", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAMEDULLARY RASP LARGE 62380111", "code_information": [{"code": "62380111", "type": "CDM"}], "standard_charges": [{"gross_charge": 1119.86, "discounted_cash": 671.92, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRAMEDULLARY RASP SMALL 62380110", "code_information": [{"code": "62380110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1007.87, "discounted_cash": 604.72, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRAMEDULLARY RASP W/ HANDLE LARGE 62387002", "code_information": [{"code": "62387002", "type": "CDM"}], "standard_charges": [{"gross_charge": 1119.86, "discounted_cash": 671.92, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRAMEDULLARY RASP W/ HANDLE SMALL 62387001", "code_information": [{"code": "62387001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1007.87, "discounted_cash": 604.72, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRANASAL RECONSTRUCTION", "code_information": [{"code": "30620", "type": "CPT"}], "standard_charges": [{"minimum": 3869.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAOCULAR PROCEDURES WITH CC/MCC", "code_information": [{"code": "116", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12536.72, "maximum": 18925.26, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 18925.26, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12536.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAOCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "117", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7358.35, "maximum": 11480.37, "setting": 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55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee 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SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6688.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6336.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4717.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS CIRCUIT", "code_information": [{"code": "36902", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS CIRCUIT", "code_information": [{"code": "36903", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO GASTROINTESTINAL TUBE", "code_information": [{"code": "44500", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO MIX SALINE&AIR F/SSG", "code_information": [{"code": "568T", "type": "CPT"}], "standard_charges": [{"minimum": 3004.0, "maximum": 4173.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO NDL ICATH UPR/LXTR ART", "code_information": [{"code": "36140", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO WINDPIPE WIRE/TUBE", "code_information": [{"code": "31730", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRODUCER ABDOMINAL 21MM TRANS ANAL DISP", "code_information": [{"code": "EEATAID21D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 222.45, "discounted_cash": 133.47, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER BOUGIE 10FR 70CM PEDI TRACH", "code_information": [{"code": "9-0211-70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.39, "discounted_cash": 20.03, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER CATHETER PIRITONEAL PI-93", "code_information": [{"code": "PI-93", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.61, "discounted_cash": 96.97, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER DIMOND/BEVEL EXPRESS OID SIZE 2", "code_information": [{"code": "T34A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1733.27, "discounted_cash": 1039.96, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER GUIDE INSIDE-OUT INTRODUCERS SINGLE USE WINGED  CAL-WI", "code_information": [{"code": "CAL-WI", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.04, "discounted_cash": 58.82, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER SET DESILETS-HOFFMAN INTRODUCER SET", "code_information": [{"code": "G18089", "type": "CDM"}], "standard_charges": [{"gross_charge": 401.1, "discounted_cash": 240.66, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER TRANS ANAL/ABDOMINAL 25MM STAPLER", "code_information": [{"code": "EEATAID25D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 222.45, "discounted_cash": 133.47, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER TUBE 15FR X 60 CM TRACH", "code_information": [{"code": "153014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.44, "discounted_cash": 35.66, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER TUBE 7.5MM TRACHEAL COUDE TIP", "code_information": [{"code": "9-0202-99", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.15, "discounted_cash": 32.49, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER TUBE 7MM TRACHEAL COUDE TIP", "code_information": [{"code": "9021270", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.62, "discounted_cash": 18.37, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER TUBE 7MM X 15FR ENDO COUDE TIP", "code_information": [{"code": "9-0212-70", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.22, "discounted_cash": 19.33, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRVASC US NONCORONARY 1ST", "code_information": [{"code": "37252", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRVASC US NONCORONARY ADDL", "code_information": [{"code": "37253", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTUBATION BICANALICULUS CRAWFORD ROUNDED OLIVE TIP NON TRAUMATIC SILICONE TUBIN", 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"standard_charges": [{"minimum": 843.15, "maximum": 18989.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO ANAL GAST N-STIM INIT", "code_information": [{"code": "95980", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IO ANAL GAST N-STIM SUBSQ", "code_information": [{"code": "95981", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO GA N-STIM SUBSQ W/REPROG", "code_information": [{"code": "95982", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO RAD TX DELIVER BY ELCTRNS", "code_information": [{"code": "77425", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 33664.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 33664.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 28613.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO RAD TX DELIVERY BY X-RAY", "code_information": [{"code": "77424", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 33664.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 33664.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 28613.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO RADIATION TX MANAGEMENT", "code_information": [{"code": "77469", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO-FLEX  CONTRA IRRIGATION CANNULA iO-CC", "code_information": [{"code": "IO-CC", "type": "CDM"}], "standard_charges": [{"gross_charge": 120.64, "discounted_cash": 72.38, "setting": "both", "billing_class": "facility"}]}, {"description": "IODINE I-123 SOD IODIDE MIC", "code_information": [{"code": "A9516", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 576.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 606.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 546.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 406.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1022.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 868.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IR Urography Inf w/Nephrotomograph 74415", "code_information": [{"code": "74415", "type": "CPT"}, {"code": "1171966", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 599.72, "maximum": 8427.0, "gross_charge": 1276.0, "discounted_cash": 765.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 701.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 599.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 638.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 663.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 644.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1294.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1294.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1362.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 652.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 789.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 670.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IR Wrist Arthrography Left 73115", "code_information": [{"code": "73115", "type": "CPT"}, {"code": "1171981", "type": "CDM"}, {"code": "322", "type": "RC"}], "standard_charges": [{"minimum": 115.3, "maximum": 8427.0, "gross_charge": 380.0, "discounted_cash": 228.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 209.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 178.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 190.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 197.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 115.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 231.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", 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"percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, bupivicaine hydro", "code_information": [{"code": "S0020", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, clindamycin phosp", "code_information": [{"code": "S0077", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection, metronidazole", "code_information": [{"code": "S0030", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", 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{"description": "Injection, ustekinumab-aauz (Otulfi), biosimilar, 1 mg", "code_information": [{"code": "Q9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Inpatient Hospital 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[{"code": "800", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 67.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inpatient Renal Dialysis Inpatient Continuous Ambulatory Peritoneal Dialysis (Capd)", "code_information": [{"code": "803", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and 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"plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Insertion Of Catheter Into Right And Left Heart Chambers Through Existing Septal Opening For Evaluation Of Congenital Abnormalities", "code_information": [{"code": "93533", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 15456.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Insertion Or Replacement Of Complete Neurostimulator System For Treatment Of Central Sleep Apnea, Complete System", "code_information": [{"code": "424T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 6734.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Insertion Or Replacement Of Complete Neurostimulator System For Treatment Of Central Sleep Apnea, Sensing Leads Only", "code_information": [{"code": "425T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 6734.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Insertion Or Replacement Of Pulse Generator Of Neurostimulator System For Treatment Of Central Sleep 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1063.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2136.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2136.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2248.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 967.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1943.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1943.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2045.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1840.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1370.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K FLOW/FUNCT IMAGE W/O DRUG", "code_information": [{"code": "78707", "type": "CPT"}], "standard_charges": [{"minimum": 968.07, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 968.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1944.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1944.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2046.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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"standard_charges": [{"gross_charge": 95.68, "discounted_cash": 57.41, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE 0.9 K09100", "code_information": [{"code": "K09100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 195.92, "discounted_cash": 117.55, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE 1.6 X 180 TROCAR POINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NK0016-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 82.5, "discounted_cash": 49.5, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE 2IN LONGER ROUND NITROL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2013-0053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE 570MM X 1.4DIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SA328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE DIA. 25 X 240 MM STERILE 9095.11.953.S", "code_information": [{"code": "9095.11.953.S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 452.2, "discounted_cash": 271.32, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE DRILL TIP 2.0 X 234 MM", "code_information": [{"code": "705002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 167.1, "discounted_cash": 100.26, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE KWK 101", "code_information": [{"code": "KWK 101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 412.3, "discounted_cash": 247.38, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE MAX VPC 0.90 X 95", "code_information": [{"code": "231209095", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.4, "discounted_cash": 99.84, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE WITH TROCAR POINT 1.5MM X 150MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NK0015-15", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 100.68, "discounted_cash": 60.41, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE  0.9MM X 152MM  DOUBLE TROCAR KWIR-HCS-09152", "code_information": [{"code": "KWIR-HCS-09152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 122.3, "discounted_cash": 73.38, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE  1.5MM X 127MM KWIR-DES-15127", "code_information": [{"code": "KWIR-DES-15127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 123.97, "discounted_cash": 74.38, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE  1.5MM X 127MM KWIR-STD-15127", "code_information": [{"code": "KWIR-STD-15127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.84, "discounted_cash": 59.9, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE  HCS  1.4MM X 165MM KWIR-HCS-14165", "code_information": [{"code": "KWIR-HCS-14165", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 149.0, "discounted_cash": 89.4, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE  STANDARD TIP  .9MM X 152MM KWIR-STD-09152", "code_information": [{"code": "KWIR-STD-09152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.32, "discounted_cash": 67.39, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE  STANDARD TIP  1.1 MM X 152 MM KWIR-PLS-11152", "code_information": [{"code": "KWIR-PLS-11152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 123.97, "discounted_cash": 74.38, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE  STANDARD TIP  2.0 MM X 152 MM KWIR-STD-20152", "code_information": [{"code": "KWIR-STD-20152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 133.12, "discounted_cash": 79.87, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE .035IN X 6.0IN", "code_information": [{"code": "WS-0906ST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 149.76, "discounted_cash": 89.86, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.9 X 150MM SMOOTH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P99-192-0915", 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"billing_class": "facility"}]}, {"description": "K-WIRE 0.9MM X-SMALL/SMALL PHALINX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45302001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 48.6, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.1/100 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WIRE-1.1/100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 57.6, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.1MM X 102MM  SMOOTH SINGLE TROCAR POINT KW11-102", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KW11-102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 228.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.2 X 50MM  P99-192-1215", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "P99-192-1215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.2MM EMINENT EXTREMITIES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FPI-1030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 72.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.35MM X 170MM AR-8610K-43", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8610K-43", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 72.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.4 / 2.0MM 56021420", "code_information": [{"code": "56021420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 62.4, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.4MM  X 150MM", "code_information": [{"code": "DSDS1014S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 62.4, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.4MM X 203MM SINGLE TROCAR KWIR-ST-14203", "code_information": [{"code": "KWIR-ST-14203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 192.76, "discounted_cash": 115.66, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.6 X 150MM TROCAR POINT", "code_information": [{"code": "NK0016-15", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 133.24, "discounted_cash": 79.94, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.6/065", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WIRE-1.6/065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 54.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.6/100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WIRE-1.6/100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 54.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.6MM -1.65MM THREADED 705800", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "705800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 578.0, "discounted_cash": 346.8, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.6MM 450MM  SHARP TIP 685.008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "685.008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.6MM CD-FX-0016", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CD-FX-0016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 72.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.6MM X 127MM SINGLE DIAMOND KWIR-SD-16127", "code_information": [{"code": "KWIR-SD-16127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 183.04, "discounted_cash": 109.82, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.6MM X 150MM  SMOOTH SINGLE TROCAR POINT KW16-150", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "KW16-150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 444.0, "discounted_cash": 266.4, "setting": "both", "billing_class": 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50575", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50557", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50576", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50580", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY FUNCTION STUDY", "code_information": [{"code": "78725", "type": "CPT"}], "standard_charges": [{"minimum": 478.21, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 478.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 960.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 960.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1010.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 909.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 677.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY IMAGING MORPHOL", "code_information": [{"code": "78700", "type": "CPT"}], "standard_charges": [{"minimum": 308.91, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 308.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 620.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 620.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 653.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 587.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 437.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY IMAGING WITH FLOW", "code_information": [{"code": "78701", "type": "CPT"}], "standard_charges": [{"minimum": 278.12, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 278.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 558.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 558.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 587.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 529.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 393.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY TRANSPLANT", "code_information": [{"code": "652", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 54.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 59.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 44.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "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": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC", "code_information": [{"code": "650", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 54.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 59.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 44.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC", "code_information": [{"code": "651", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 54.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 59.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 44.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KIRSCHNER TAMP FOR 1.6MM  WIRE 03.606.022", "code_information": [{"code": "3.606.022", "type": "CDM"}], "standard_charges": [{"gross_charge": 1290.1, "discounted_cash": 774.06, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT  DRESSING EAR ADULT STERILE S-1000", "code_information": [{"code": "S-1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.8, "discounted_cash": 41.28, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT  JACKSON SPINAL CARE  LF 5808", "code_information": [{"code": "5808", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 102.63, "discounted_cash": 61.58, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT  LEAD IMPLANT 1801", "code_information": [{"code": "1801", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 984.0, "discounted_cash": 590.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT  SLIDE  HEMOCCULT SINGLE 60151A", "code_information": [{"code": "60151A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.56, "discounted_cash": 2.74, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT 10 GAUGE 10MM iVAS ELITE FRACTURE KIT", "code_information": [{"code": "808-010-800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4399.92, "discounted_cash": 2639.95, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT 10 GAUGE 20MM IVAS ELITE FRACTURE KIT", "code_information": [{"code": "808-020-800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4399.92, "discounted_cash": 2639.95, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT 11G IVAS BONE BIOPSY", "code_information": [{"code": "306-116-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 233.59, "discounted_cash": 140.15, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT 2-LUMEN 8 FR X 20 CM CVC AK-45802-SK", "code_information": [{"code": "AK-45802-SK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 211.5, "discounted_cash": 126.9, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT 36 PIECE LAPAROSCOPY PLUS II SPP99LS1AA", "code_information": [{"code": "SPP99LS1AA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.43, "discounted_cash": 63.86, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT 3CC SCP FRACTURE FOOT AND ANKLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "514.315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7722.0, "discounted_cash": 4633.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT 520MM STERILE RIA 2 BONE HARVESTING  03.404.000S", "code_information": [{"code": "3.404.000S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6091.2, "discounted_cash": 3654.72, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ABLATION ENDO NOVASURE SURESOUND POLY STRL", "code_information": [{"code": "NS2007US", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2484.0, "discounted_cash": 1490.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACC LEAD INTRODUCER", "code_information": [{"code": "3550-18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 744.8, "discounted_cash": 446.88, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACC LEADINTRODUCER 2 NDLS GROUND PADS TEST CABLE PATIENT CABLE AND DILATOR", "code_information": [{"code": "355018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 744.8, "discounted_cash": 446.88, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESS 10G DIAMOND SIDE", "code_information": [{"code": "3.804.519S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 189.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESS 10G VBS BEVELED TIP", "code_information": [{"code": "3.804.520S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 189.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESS DIAMOND TIP 10GA END OPENING", "code_information": [{"code": "3.804.517S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 189.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESS LATERAL", "code_information": [{"code": "8700-9112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6118.01, "discounted_cash": 3670.81, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESS THREE REAMERS FINE", "code_information": [{"code": "TDAK0020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1313.74, "discounted_cash": 788.24, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESS URINARY CONTROL SYS", "code_information": [{"code": "C1815", "type": "HCPCS"}, {"code": "720066-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3875.46, "discounted_cash": 2325.28, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESSORY 1IN X 8IN LEAD REV STIMULATION", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3550-27", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 931.0, "discounted_cash": 558.6, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESSORY AMS 700", "code_information": [{"code": "72401850", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1405.51, "discounted_cash": 843.31, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESSORY PLUG AND BOOT", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "3550-29", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 284.4, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCUPORT SIDE SCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "402.202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8567.0, "discounted_cash": 5140.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCY 3560031 ISTM REVISION  3560031", "code_information": [{"code": "3560031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.7, "discounted_cash": 630.42, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACL ANATOMIC DISP", "code_information": [{"code": "8820", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 405.27, "discounted_cash": 243.16, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACL DISPOSABLE", "code_information": [{"code": "8800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 383.34, "discounted_cash": 230.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACL UNIVERSAL", "code_information": [{"code": "8821", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 405.27, "discounted_cash": 243.16, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT AIRWAY 24FR ROBERTAZZI NASOPHARYNGEAL  DYNJNASO24", "code_information": [{"code": "DYNJNASO24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.75, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT AIRWAY 28FR ROBERTAZZI NASOPHARYNGEAL  DYNJNASO28", "code_information": [{"code": "DYNJNASO28", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.9, "discounted_cash": 16.74, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT AIRWAY 34FR ROBERTAZZI NASOPHARYNGEAL  DYNJNASO34", "code_information": [{"code": "DYNJNASO34", "type": "CDM"}, {"code": "272", "type": "RC"}], 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"standard_charge_dollar": 95.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 100.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 90.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 67.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 23.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 20.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Ketones Urine", "code_information": [{"code": "84600", "type": "CPT"}, {"code": "633769", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "gross_charge": 361.0, "discounted_cash": 216.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee 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"BCBS PPO DFW", "standard_charge_dollar": 139.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 125.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 93.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 50.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 42.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L CR E-MAXTM VITAMIN E CONGRUENT TIBIAL INSERT SZ C 10MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1201-131-510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2464.0, "discounted_cash": 1478.4, "setting": "both", "billing_class": "facility"}]}, {"description": "L HRT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7523", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT ANGIO W/FLOW RESRV", "code_information": [{"code": "C7524", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT ART/GRFT ANGIO", "code_information": [{"code": "93459", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 15456.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14607.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 11708.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11123.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10537.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 9952.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT ARTERY/VENTRICLE ANGIO", "code_information": [{"code": "93458", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 15456.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14607.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 11708.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11123.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10537.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 9952.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT CATH CHD NM/ABN NT CNJ", "code_information": [{"code": "93595", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT CATH TRNSPTL PUNCTURE", "code_information": [{"code": "93462", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 15456.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14607.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 11708.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11123.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10537.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 9952.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT GFT ANG W/ IVUS OR OCT", "code_information": [{"code": "C7525", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT GFT 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L VENTRIC PACING LEAD ADD-ON", "code_information": [{"code": "33225", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 23180.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 13391.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 23180.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"code": "PHLL-5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1710.0, "discounted_cash": 1026.0, "setting": "both", "billing_class": "facility"}]}, {"description": "L-WIRE 1.6/100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WIRE-1.6-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 54.0, "setting": "both", "billing_class": "facility"}]}, {"description": "L/S RATIO FETAL LUNG", "code_information": [{"code": "83661", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 167.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 336.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 336.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 354.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 319.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 237.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 64.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 54.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LABEL 1664011 SOLERA VYGR GENERAL INSTR 1664011", "code_information": [{"code": "1664011", "type": "CDM"}], "standard_charges": [{"gross_charge": 56.66, "discounted_cash": 34.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LABEL 1664014 CDHS VOYAGER 4.75 MAS SET 1664014", "code_information": [{"code": "1664014", "type": "CDM"}], "standard_charges": [{"gross_charge": 56.66, "discounted_cash": 34.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LABEL 3036011 ZEVO SD DEGEN SET 3036011", "code_information": [{"code": "3036011", "type": "CDM"}], "standard_charges": [{"gross_charge": 67.08, "discounted_cash": 40.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LABEL 3036019 ZEVO ST DEGEN SET 3036019", "code_information": [{"code": "3036019", "type": "CDM"}], "standard_charges": [{"gross_charge": 67.08, "discounted_cash": 40.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LABEL 3036030 ZEVO SET 3036030", "code_information": [{"code": "3036030", "type": "CDM"}], "standard_charges": [{"gross_charge": 67.08, "discounted_cash": 40.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LABEL 7742000 DIVERG NO-P PARALLEL 7742000", "code_information": [{"code": "7742000", "type": "CDM"}], "standard_charges": [{"gross_charge": 69.66, "discounted_cash": 41.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LABEL KIT ASSEMBLY PATIENT RECORD  519150", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "519150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2229.0, "discounted_cash": 1337.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LABYRINTHECTOMY;TRANSCANAL 69905", "code_information": [{"code": "69905", "type": "CPT"}, {"code": "1481183", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8536.0, "gross_charge": 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SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP COLECTOMY W/PROCTECTOMY", "code_information": [{"code": "44211", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP COLOSTOMY", "code_information": [{"code": "44188", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP ESOPH LENGTHENING", "code_information": [{"code": "43283", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP ESOPHAGOMYOTOMY", "code_information": [{"code": "S2079", "type": "HCPCS"}], "standard_charges": [{"minimum": 6850.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP GASTR BYPASS INCL SMLL I", "code_information": [{"code": "43645", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 19020.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 10820.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 16760.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8850.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 14246.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16095.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 10988.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 19020.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17118.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP GASTRIC BYPASS/ROUX-EN-Y", "code_information": [{"code": "43644", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 19020.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 10820.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 16760.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8850.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 14246.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16095.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 10988.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 19020.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17118.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP ILEO/JEJUNO-STOMY", "code_information": [{"code": "44187", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP IMPL ELECTRODE ANTRUM", "code_information": [{"code": "43647", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP INS DEVICE FOR RT", "code_information": [{"code": "49327", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP JEJUNOSTOMY", "code_information": [{"code": "44186", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP MYOTOMY HELLER", "code_information": [{"code": "43279", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP PARAESOPH HER RPR W/MESH", "code_information": [{"code": "43282", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP PROCTOPEXY W/SIG RESECT", "code_information": [{"code": "45402", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP RADICAL HYST", "code_information": [{"code": "58548", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP REMOVAL OF RECTUM", "code_information": [{"code": "45395", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP REPLACE GASTR ADJ DEVICE", "code_information": [{"code": "43773", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 19020.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 10820.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 16760.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8850.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 14246.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16095.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 10988.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 19020.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17118.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP RESECT S/INTESTINE ADDL", "code_information": [{"code": "44203", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP REVISE GASTR ADJ DEVICE", "code_information": [{"code": "43771", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 19020.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee 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"CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 14246.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16095.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 10988.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 19020.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 17118.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP REVISE/REMV ELTRD ANTRUM", "code_information": [{"code": "43648", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP-SCOPIC PORT DRIVER CAP RFB 894-515R", "code_information": [{"code": "894-515R", "type": "CDM"}], "standard_charges": [{"gross_charge": 888.17, "discounted_cash": 532.9, "setting": "both", "billing_class": "facility"}]}, {"description": "LAP.SUPRACERVICAL HYST.UTERUS 250 G OR LESS W/REM.TUBES/OVARY 58542", "code_information": [{"code": "58542", "type": "CPT"}, 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"standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP.TOTAL HYST.GREATER THAN 250 G W/REM.OF TUBES/OVARY 58573", "code_information": [{"code": "58573", "type": "CPT"}, {"code": "1481226", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14275.0, "gross_charge": 20060.0, "discounted_cash": 12036.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", 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"standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", 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"standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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[{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT ISDSS EA", "code_information": [{"code": "676T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT PRM ISDSS", "code_information": [{"code": "674T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 37880.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 37880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34092.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS ISLET CELL TRANSPLANT", "code_information": [{"code": "585T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS PELVIC LYMPHADEC", "code_information": [{"code": "38573", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS REPOS LEAD ISDSS 1ST LD", "code_information": [{"code": "677T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS REPOS LEAD ISDSS EA ADD", "code_information": [{"code": "678T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS RMVL LEAD ISDSS", "code_information": [{"code": "679T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS TOT HYST RESJ MAL", "code_information": [{"code": "58575", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARGE ADJACENT DILATOR 03.809.859", "code_information": [{"code": "3.809.859", "type": "CDM"}], "standard_charges": [{"gross_charge": 1087.94, "discounted_cash": 652.76, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE ANGLED HANDLE 05-706", "code_information": [{"code": "5-706", "type": "CDM"}], "standard_charges": [{"gross_charge": 1503.36, "discounted_cash": 902.02, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE AUGMENTED BASEPLATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "110032430", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2660.0, "discounted_cash": 1596.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE CANNULATED HANDLE 05-702", "code_information": [{"code": "5-702", "type": "CDM"}], "standard_charges": [{"gross_charge": 1503.36, "discounted_cash": 902.02, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE CAPACITY FORCEPS Large Capacity Biopsy Forceps  133-4667 Alligator Blue 230 2.8", "code_information": [{"code": "BF40286", "type": "CDM"}], "standard_charges": [{"gross_charge": 32.99, "discounted_cash": 19.79, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE CAPACITY FORCEPS Large Capacity Biopsy Forceps With Spike  133-4666 Alligator Blue 230 2.8", "code_information": [{"code": "BF40306", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.99, "discounted_cash": 19.79, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE EXTENDED BLADE LAMINA HOOK/FRONTAL 298.189", "code_information": [{"code": "298.189", "type": "CDM"}], "standard_charges": [{"gross_charge": 1260.84, "discounted_cash": 756.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE EXTENDED BLADE LAMINA HOOK/LEFT 298.187", "code_information": [{"code": "298.187", "type": "CDM"}], "standard_charges": [{"gross_charge": 1138.48, "discounted_cash": 683.09, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE EXTENDED BLADE LAMINA HOOK/RIGHT 298.188", "code_information": [{"code": "298.188", "type": "CDM"}], "standard_charges": [{"gross_charge": 1138.48, "discounted_cash": 683.09, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE KERRISON 955-542 5MM 40 DEGREES 955-542", "code_information": [{"code": "955-542", "type": "CDM"}], "standard_charges": [{"gross_charge": 1792.48, "discounted_cash": 1075.49, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE LAMINA FINDER 03.632.014", "code_information": [{"code": "3.632.014", "type": "CDM"}], "standard_charges": [{"gross_charge": 1643.76, "discounted_cash": 986.26, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE LAMINA FINDER 388.106", "code_information": [{"code": "388.106", "type": "CDM"}], "standard_charges": [{"gross_charge": 1643.76, "discounted_cash": 986.26, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE LAMINA FINDER 6041.03", "code_information": [{"code": "6041.03", "type": "CDM"}], "standard_charges": [{"gross_charge": 1122.52, "discounted_cash": 673.51, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE LAMINA HOOK FRONTAL 298.332", "code_information": [{"code": "298.332", "type": "CDM"}], "standard_charges": [{"gross_charge": 1260.84, "discounted_cash": 756.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE LAMINA HOOK LEFT 298.331", "code_information": [{"code": "298.331", "type": "CDM"}], "standard_charges": [{"gross_charge": 1138.48, "discounted_cash": 683.09, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE LAMINA HOOK RIGHT 298.330", "code_information": [{"code": "298.33", "type": "CDM"}], "standard_charges": [{"gross_charge": 1138.48, "discounted_cash": 683.09, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE LAMINA HOOK/DUAL-OPENING FRONTAL 298.329", "code_information": [{"code": "298.329", "type": "CDM"}], "standard_charges": [{"gross_charge": 1260.84, "discounted_cash": 756.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE LAMINA HOOK/DUAL-OPENING SIDE 298.328", "code_information": [{"code": "298.328", "type": "CDM"}], "standard_charges": [{"gross_charge": 1260.84, "discounted_cash": 756.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE PEC BUTTON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2267", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1866.0, "discounted_cash": 1119.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE PEDICLE FINDER 6041.0302", "code_information": [{"code": "6041.0302", "type": "CDM"}], "standard_charges": [{"gross_charge": 1122.52, "discounted_cash": 673.51, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE PEDICLE HOOK 57-3011", "code_information": [{"code": "57-3011", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE PEDICULAR POLYAXIAL HOOK 13MM B02240116", "code_information": [{"code": "B02240116", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE PEDICULAR POLYAXIAL HOOK 16MM B02240106", "code_information": [{"code": "B02240106", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE POLYAXIAL LUMBAR LAMINAR HOOK FOR CLAW B02241211", "code_information": [{"code": "B02241211", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE POLYAXIAL PEDICULAR HOOK FOR CLAW B02241106", "code_information": [{"code": "B02241106", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE POSITIONER 637.511", "code_information": [{"code": "637.511", "type": "CDM"}], "standard_charges": [{"gross_charge": 1129.68, "discounted_cash": 677.81, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE SHORT HOOK B02241116", "code_information": [{"code": "B02241116", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE TALL BODY LAMINA HOOK FRONTAL 298.179", "code_information": [{"code": "298.179", "type": "CDM"}], "standard_charges": [{"gross_charge": 1260.84, "discounted_cash": 756.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE TALL BODY LAMINA HOOK LEFT 298.177", "code_information": [{"code": "298.177", "type": "CDM"}], "standard_charges": [{"gross_charge": 1138.48, "discounted_cash": 683.09, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE TALL BODY LAMINA HOOK RIGHT 298.178", "code_information": [{"code": "298.178", "type": "CDM"}], "standard_charges": [{"gross_charge": 1138.48, "discounted_cash": 683.09, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE TALL BODY/EXTENDED BLADE LAMINA HOOK/FRONTAL 298.199", "code_information": [{"code": "298.199", "type": "CDM"}], "standard_charges": [{"gross_charge": 1260.84, "discounted_cash": 756.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE TALL BODY/EXTENDED BLADE LAMINA HOOK/LEFT 298.197", "code_information": [{"code": "298.197", "type": "CDM"}], "standard_charges": [{"gross_charge": 1138.48, "discounted_cash": 683.09, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE TALL BODY/EXTENDED BLADE LAMINA HOOK/RIGHT 298.198", "code_information": [{"code": "298.198", "type": "CDM"}], "standard_charges": [{"gross_charge": 1138.48, "discounted_cash": 683.09, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE TI LAMINA HOOK-FRONTAL 498.332", "code_information": [{"code": "498.332", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE TI LAMINA HOOK-LEFT 498.331", "code_information": [{"code": "498.331", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.66, "discounted_cash": 719.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE TI LAMINA HOOK-RIGHT 498.330", "code_information": [{"code": "498.33", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.66, "discounted_cash": 719.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE TI LAMINA HOOK/ DUAL-OPENING FRONTAL 498.329", "code_information": [{"code": "498.329", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE TI LAMINA HOOK/ DUAL-OPENING SIDE 498.328", "code_information": [{"code": "498.328", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE TI TALL BODY LAMINA HOOK/DUAL-OPENING FRONTAL 498.214", "code_information": [{"code": "498.214", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGE TI TALL BODY LAMINA HOOK/DUAL-OPENING SIDE 498.213", "code_information": [{"code": "498.213", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LARGSC W/LASER DSTRJ LES", "code_information": [{"code": "31572", "type": "CPT"}], "standard_charges": [{"minimum": 3866.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARGSC W/REMOVAL LESION", "code_information": [{"code": "31578", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARGSC W/RMVL FOREIGN BDY(S)", "code_information": [{"code": "31577", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYGOSCOPE LOPRO S3", "code_information": [{"code": "574-0194", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 163.07, "discounted_cash": 97.84, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYGOSCOPE LOPRO S4", "code_information": [{"code": "574-0195", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 163.07, "discounted_cash": 97.84, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYNGEAL FUNCTION STUDIES", "code_information": [{"code": "92520", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY CRICOID SPLIT", "code_information": [{"code": "31587", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY FX RDCTJ FIXJ", "code_information": [{"code": "31584", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31552", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31553", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31554", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL WEB", "code_information": [{"code": "31580", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOP W/ARYTENOIDECTOM", "code_information": [{"code": "31560", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPE DISP NUMBER 1 BLADE/HANDLE 040-06-0410U", "code_information": [{"code": "40-06-0410U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.87, "discounted_cash": 33.52, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYNGOSCOPE DISPOSABLE MAC #2 BLADE/HANDLE COMBO OMNI BRITEPRO", "code_information": [{"code": "40-04-0120U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.87, "discounted_cash": 33.52, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYNGOSCOPE DISPOSABLE MAC #3 BLADE/HANDLE COMBO OMNI BRITEPRO", "code_information": [{"code": "40-04-0130U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.87, "discounted_cash": 33.52, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYNGOSCOPE DISPOSABLE MAC #4 BLADE/HANDLE COMBO OMNI BRITEPRO", "code_information": [{"code": "40-04-0140U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.66, "discounted_cash": 29.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYNGOSCOPE DISPOSABLE MILLER ULTRA #2 BLADE/HANDLE COMBO OMNI BRITEPRO", "code_information": [{"code": "40-04-2020U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.66, "discounted_cash": 29.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYNGOSCOPE DISPOSABLE MILLER ULTRA #3 BLADE/HANDLE COMBO OMNI BRITEPRO", "code_information": [{"code": "40-04-2030U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.87, "discounted_cash": 33.52, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYNGOSCOPE VIDEO LOPRO SZ 3", "code_information": [{"code": "270-0938", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 158.08, "discounted_cash": 94.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYNGOSCOPE VIDEO LOPRO SZ 4", "code_information": [{"code": "270-0939", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 163.07, "discounted_cash": 97.84, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYNGOSCOPIC SENSORY I&R", "code_information": [{"code": "92615", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPIC SENSORY VID", "code_information": [{"code": "92614", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY AND DILATION", "code_information": [{"code": "31529", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY DIRECT DX EXCEPT NEWBORN 31525", "code_information": [{"code": "31525", "type": "CPT"}, {"code": "1643987", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 14275.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY DIRECT OP. W/EXC. TUMOR AND/OR STRIPPING VOCAL CORD OR EPIGLOTTIS 31540", "code_information": [{"code": "31540", "type": "CPT"}, {"code": "2013585", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY DIRECT OPERTIVE W/FOREIGN BODY REMOVAL 31530", "code_information": [{"code": "31530", "type": "CPT"}, {"code": "1697274", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY DIRECT W/ OR W/O TRACHEOSCOPY DIAG. 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"plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY FOR ASPIRATION", "code_information": [{"code": "31515", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY FOR TREATMENT", "code_information": [{"code": "31527", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY MEDIALIZATION UNILATERAL 31591", "code_information": [{"code": "31591", "type": "CPT"}, {"code": "44660534", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 10356.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY TELESCOPIC", "code_information": [{"code": "31579", "type": "CPT"}], 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/FB & OP SCOPE", "code_information": [{"code": "31531", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNSCOP REMVE CART + SCOP", "code_information": [{"code": "31561", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": 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3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER ENUCLEATION OF PROSTATE W/ MORCELLATION 52649", "code_information": [{"code": "52649", "type": "CPT"}, {"code": "1482034", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1534.5, "maximum": 14275.0, "gross_charge": 2790.0, "discounted_cash": 1674.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1534.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER FBR ROUND TIP SU 365UM 8000246", "code_information": [{"code": "8000246", "type": "CDM"}, 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"LASER HOLMIUM HIGH POWER  613", "code_information": [{"code": "613", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.49, "discounted_cash": 15.89, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER IN SITU KERATOMILEUSIS", "code_information": [{"code": "S0800", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, 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1227.31, "setting": "both", "billing_class": "facility"}]}, {"description": "LATERAL HOOK HOLDER 6119.802", "code_information": [{"code": "6119.802", "type": "CDM"}], "standard_charges": [{"gross_charge": 2045.52, "discounted_cash": 1227.31, "setting": "both", "billing_class": "facility"}]}, {"description": "LATERAL HOOK HOLDER 6120.802", "code_information": [{"code": "6120.802", "type": "CDM"}], "standard_charges": [{"gross_charge": 2045.52, "discounted_cash": 1227.31, "setting": "both", "billing_class": "facility"}]}, {"description": "LATERAL HOOK HOLDER 624.307", "code_information": [{"code": "624.307", "type": "CDM"}], "standard_charges": [{"gross_charge": 1704.24, "discounted_cash": 1022.54, "setting": "both", "billing_class": "facility"}]}, {"description": "LATERAL HOOK HOLDER 634.307", "code_information": [{"code": "634.307", "type": "CDM"}], "standard_charges": [{"gross_charge": 1704.24, "discounted_cash": 1022.54, "setting": "both", "billing_class": "facility"}]}, {"description": "LATERAL MONITORING KIT 8700-9121", "code_information": [{"code": "8700-9121", "type": "CDM"}], "standard_charges": [{"gross_charge": 2019.6, "discounted_cash": 1211.76, "setting": "both", "billing_class": "facility"}]}, {"description": "LATERAL OFFSET CONNECTOR OPEN SIZE 3.5/4.0 MM 30 MM 7601-73530", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7601-73530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LATERAL PLANER 136-00200", "code_information": [{"code": "136-00200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1829.52, "discounted_cash": 1097.71, "setting": "both", "billing_class": "facility"}]}, {"description": "LATERAL RETINACULAR RELEASE OPEN 27425", "code_information": [{"code": "27425", "type": "CPT"}, {"code": "1481257", "type": "CDM"}, {"code": "360", 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{"description": "LEFORT III W/O LEFORT I", "code_information": [{"code": "21154", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": 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"standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFT 10MM  FIXED BEARING CONSTRAINED POSTERIOR  STABILIZED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5126-007-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4420.0, "discounted_cash": 2652.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEFT ANGLED HOOK  LARGE 14-581260L", "code_information": [{"code": "14-581260L", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEFT ANGLED HOOK  MEDIUM 14-581245L", "code_information": [{"code": "14-581245L", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEFT ANGLED HOOK  SMALL 14-581230L", "code_information": [{"code": "14-581230L", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEFT ANGLED HOOK 179752070", "code_information": [{"code": "179752070", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEFT HRT CATH W/VENTRCLGRPHY", "code_information": [{"code": "93452", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 15456.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee 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CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14607.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 11708.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11123.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10537.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 9952.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFT OFFSET HOOK 179752090", "code_information": [{"code": "179752090", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEFT POLYAXIAL TP HOOK  11MM  0 OFFSET B02240011L", "code_information": [{"code": "B02240011L", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEFT POLYAXIAL TP HOOK  9MM  0 OFFSET B02240009L", "code_information": [{"code": "B02240009L", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEFT POLYAXIAL TP HOOK  LARGE OFFSET  11MM B02245011L", "code_information": [{"code": "B02245011L", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEFT POLYAXIAL TP HOOK  LARGE OFFSET  9MM B02245009L", "code_information": [{"code": "B02245009L", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEFT POLYAXIAL TP HOOK  REDUCED OFFSET 11MM B02242511L", "code_information": [{"code": "B02242511L", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEFT POLYAXIAL TP HOOK  REDUCED OFFSET 9MM B02242509L", "code_information": [{"code": "B02242509L", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEG STRAP MED SUSPENSORY W/O  4509202262", "code_information": [{"code": "4509202262", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.26, "discounted_cash": 17.56, "setting": "both", "billing_class": "facility"}]}, {"description": "LEG STRAPS LARGE SUSPENSORY W/O  4509202430", "code_information": [{"code": "4509202430", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.06, "discounted_cash": 18.04, "setting": "both", "billing_class": "facility"}]}, {"description": "LEG VEIN FUSION", "code_information": [{"code": "34530", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGGINGS DRAPE DISPOSABLE 20 CS 8420", "code_information": [{"code": "8420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.89, "discounted_cash": 7.13, "setting": "both", "billing_class": "facility"}]}, {"description": "LEGION PNEUMO DNA AMP PROB", "code_information": [{"code": "87541", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 287.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 577.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 577.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 607.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 546.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 407.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 102.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 87.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMO DNA DIR PROB", "code_information": [{"code": "87540", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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[{"gross_charge": 392.0, "discounted_cash": 235.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 34.0D DCB0000340", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000340", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 392.0, "discounted_cash": 235.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 5.0D DCB0000050", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000050", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 392.0, "discounted_cash": 235.2, "setting": "both", "billing_class": "facility"}]}, {"description": "LEN IOL TECNIS SMPLCTY TECNIS 1PC CLR MONO 5.5D DCB0000055", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "DCB0000055", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": 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7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR 27428", "code_information": [{"code": "27428", "type": "CPT"}, {"code": "1481262", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8945.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR OPEN 27429", "code_information": [{"code": "27429", "type": "CPT"}, {"code": "1481263", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8945.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGASURE BLUNT TIP 44CM LF1844", "code_information": [{"code": "LF1844", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1316.7, "discounted_cash": 790.02, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGASURE BLUNT TIP LAPAROSCOPIC 14.5 X 5MM", "code_information": [{"code": "LF1637", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1172.4, "discounted_cash": 703.44, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGASURE BLUNT TIP LAPAROSCOPIC 20 X 5MM", "code_information": [{"code": "LF1644", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1312.5, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGASURE IMPACT", "code_information": [{"code": "LF4318", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1439.1, "discounted_cash": 863.46, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGASURE LAPROSCOPIC 23CM MARYLAND JAW OPEN DEVICE", "code_information": [{"code": "LF1723", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1282.97, "discounted_cash": 769.78, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGASURE MARYLAND JAW 5MM-37 CM", "code_information": [{"code": "LF1737", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1270.01, "discounted_cash": 762.01, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGASURE RETRACT L-HOOK 37CMLIGASURE LF5637", "code_information": [{"code": "LF5637", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1305.72, "discounted_cash": 783.43, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGATE ESOPHAGUS VEINS", "code_information": [{"code": "43400", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE LEG VEINS OPEN", "code_information": [{"code": "37761", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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[{"code": "37760", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE/STAPLE ESOPHAGUS", "code_information": [{"code": "43405", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE/STRIP LONG LEG VEIN", "code_information": [{"code": "37722", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE/STRIP SHORT LEG VEIN", "code_information": [{"code": "37718", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION DIVISION AND/OR EXCISION OF VARICOSE VEIN CLUSTER 1 LEG 37785", "code_information": [{"code": "37785", "type": "CPT"}, {"code": "2001903", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION NASAL SINUS ARTERY", "code_information": [{"code": "30915", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF A-V FISTULA", "code_information": [{"code": "37607", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF ABDOMEN ARTERY", "code_information": [{"code": "37617", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF CHEST ARTERY", "code_information": [{"code": "37616", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF EXTREMITY ARTERY", "code_information": [{"code": "37618", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF INF VENA CAVA", "code_information": [{"code": "37619", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37600", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37606", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37615", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF SALIVARY DUCT", "code_information": [{"code": 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8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF SHUNT", "code_information": [{"code": "49428", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OR BIOPSY TEMPORAL ARTERY 37609", "code_information": [{"code": "37609", "type": "CPT"}, {"code": "2034643", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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8242.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 7555.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET 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"standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITT ICR MLT TRJ MLT/CPLX LS", "code_information": [{"code": "61737", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER", "code_information": [{"code": "80076", "type": "CPT"}, {"code": "1233827", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "gross_charge": 284.0, "discounted_cash": 170.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 891.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 802.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 597.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": 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"plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 343.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 690.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 690.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 727.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 654.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 487.2, "methodology": "fee 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[{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1474.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1252.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER DS 10 BIOCHEM ASY SRM", "code_information": [{"code": "166U", "type": "CPT"}], "standard_charges": [{"minimum": 1252.89, "maximum": 1474.08, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1474.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1252.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER DS ALYS 3 BMRK SRM ALG", "code_information": [{"code": "81517", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 388.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 779.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 779.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 820.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 738.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 550.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER ELASTOGRAPHY", "code_information": [{"code": "91200", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER IMAGING", "code_information": [{"code": "78201", "type": "CPT"}], "standard_charges": [{"minimum": 186.7, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 186.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 374.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 374.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 394.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 355.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 264.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER IMAGING WITH FLOW", "code_information": [{"code": "78202", "type": "CPT"}], "standard_charges": [{"minimum": 376.17, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 376.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 755.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 755.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 795.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 715.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 532.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT", "code_information": [{"code": "5", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 54.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 59.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 44.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "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": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIVER TRANSPLANT WITHOUT MCC", "code_information": [{"code": "6", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 54.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 59.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 44.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "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": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LJS-E BASE PLANT ASSEMBLY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "IJS-EL8-BPA", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10263.6, "discounted_cash": 6158.16, "setting": "both", "billing_class": "facility"}]}, {"description": "LL FIBER ROUND TIP SU 200UM 8000147", "code_information": [{"code": "8000147", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 284.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LLIF SPACER HA PEEK 18 X 45 X 10 15DEG GA184510D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GA184510D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8580.0, "discounted_cash": 5148.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LLIF SPACER HA PEEK 18MM X 45MMX12MMX15", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GA184512D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8580.0, "discounted_cash": 5148.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LLIF SPACER HA PEEK 18MM X 50MMX12MMX15", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GA185012D", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8580.0, "discounted_cash": 5148.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LMA SUPREME SIZE 1 ALBF010SU", "code_information": [{"code": "ALBF010SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.18, "discounted_cash": 32.51, "setting": "both", "billing_class": "facility"}]}, {"description": "LMA SUPREME SIZE 1.5 ALBF015SU", "code_information": [{"code": "ALBF015SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.18, "discounted_cash": 32.51, "setting": "both", "billing_class": "facility"}]}, {"description": "LMA SUPREME SIZE 2 ALBF020SU", "code_information": [{"code": "ALBF020SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.18, "discounted_cash": 32.51, "setting": "both", "billing_class": "facility"}]}, {"description": "LMA SUPREME SIZE 2.5 ALBF025SU", "code_information": [{"code": "ALBF025SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.18, "discounted_cash": 32.51, "setting": "both", "billing_class": "facility"}]}, {"description": "LMH BROACH LMH-1009", "code_information": [{"code": "LMH-1009", "type": "CDM"}], "standard_charges": [{"gross_charge": 1138.48, "discounted_cash": 683.09, "setting": "both", "billing_class": "facility"}]}, {"description": "LMTD OPH EXAM GENERAL ANES", "code_information": [{"code": "92019", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LNGVTY&MRTLTY RSK MRNA 18GEN", "code_information": [{"code": "294U", "type": "CPT"}], "standard_charges": [{"minimum": 1891.53, "maximum": 2225.47, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2225.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1891.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOBAR LUNG TRANSPLANTATION", "code_information": [{"code": "S2060", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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"HCPCS"}, {"code": "14355075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC ROD RELINE-O TI   5.5X80MM  14355080", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14355080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC ROD RELINE-O TI   5.5X90MM  14355090", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "14355090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC ROD VIPER2  ROD-35MM 186788035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "186788035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC ROD VIPER2  ROD-55MM 186788055", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "186788055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC ROD VIPER2  ROD-75MM 186788075", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "186788075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC SPACER ACF TRIAL RASP- 10MM HEIGHT 03.810.006", "code_information": [{"code": "3.810.006", "type": "CDM"}], "standard_charges": [{"gross_charge": 2360.88, "discounted_cash": 1416.53, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC SPACER ACF TRIAL RASP- 11MM HEIGHT 03.810.007", "code_information": [{"code": "3.810.007", "type": "CDM"}], "standard_charges": [{"gross_charge": 2360.88, "discounted_cash": 1416.53, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC SPACER ACF TRIAL RASP- 12MM HEIGHT 03.810.008", "code_information": [{"code": "3.810.008", "type": "CDM"}], "standard_charges": [{"gross_charge": 2360.88, "discounted_cash": 1416.53, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC SPACER ACF TRIAL RASP- 5MM HEIGHT 03.810.001", "code_information": [{"code": "3.810.001", "type": "CDM"}], "standard_charges": [{"gross_charge": 2360.88, "discounted_cash": 1416.53, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC SPACER ACF TRIAL RASP- 6MM HEIGHT 03.810.002", "code_information": [{"code": "3.810.002", "type": "CDM"}], "standard_charges": [{"gross_charge": 2360.88, "discounted_cash": 1416.53, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC SPACER ACF TRIAL RASP- 7MM HEIGHT 03.810.003", "code_information": [{"code": "3.810.003", "type": "CDM"}], "standard_charges": [{"gross_charge": 2360.88, "discounted_cash": 1416.53, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC SPACER ACF TRIAL RASP- 8MM HEIGHT 03.810.004", "code_information": [{"code": "3.810.004", "type": "CDM"}], "standard_charges": [{"gross_charge": 2360.88, "discounted_cash": 1416.53, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC SPACER ACF TRIAL RASP- 9MM HEIGHT 03.810.005", "code_information": [{"code": "3.810.005", "type": "CDM"}], "standard_charges": [{"gross_charge": 2360.88, "discounted_cash": 1416.53, "setting": "both", "billing_class": "facility"}]}, {"description": "LOUDNESS BALANCE TEST", "code_information": [{"code": "92562", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5271", "type": "HCPCS"}], "standard_charges": [{"minimum": 1659.0, "maximum": 4173.0, "setting": "outpatient", 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5275", "type": "HCPCS"}], "standard_charges": [{"minimum": 1659.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5276", "type": "HCPCS"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5277", "type": "HCPCS"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5278", "type": "HCPCS"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW FREQUENCY NON-THERMAL US", "code_information": [{"code": "97610", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW PROFILE 2-HOLE COVER 8606-0200", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8606-0200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3913.0, "discounted_cash": 2347.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LOW PROFILE U-JOINT AWL FOR SYNFIX MINI-OPEN 03.802.230", "code_information": [{"code": "3.802.230", "type": "CDM"}], "standard_charges": [{"gross_charge": 5149.44, "discounted_cash": 3089.66, "setting": "both", "billing_class": "facility"}]}, {"description": "LOW-LEVEL LASER THERAPY", "code_information": [{"code": "552T", "type": "CPT"}], "standard_charges": [{"minimum": 3004.0, "maximum": 4173.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC", "code_information": [{"code": "493", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3870.0, "maximum": 27232.14, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 27232.14, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 4732.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7533.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 3870.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 6403.0, 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"methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 4699.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC", "code_information": [{"code": "494", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3870.0, "maximum": 21384.21, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee 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"standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LP PEGGED TALAR PLATE RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6000502R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8273.2, "discounted_cash": 4963.92, "setting": "both", "billing_class": "facility"}]}, {"description": "LPOPRTN BLD W/5 MAJ CLASSES", "code_information": [{"code": "52U", "type": "CPT"}], "standard_charges": [{"minimum": 84.28, "maximum": 99.16, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 99.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 84.28, "methodology": "fee schedule"}], "billing_class": 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DURAL RETRACTOR E900-012", "code_information": [{"code": "E900-012", "type": "CDM"}], "standard_charges": [{"gross_charge": 403.69, "discounted_cash": 242.21, "setting": "both", "billing_class": "facility"}]}, {"description": "LRNSCP FLX 3.8IN ASCOPE 3 INTBT HNDL LUER CONN LEN DSGN BEND", "code_information": [{"code": "402001000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 720.7, "discounted_cash": 432.42, "setting": "both", "billing_class": "facility"}]}, {"description": "LSH UTERUS ABOVE 250 G", "code_information": [{"code": "58543", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LSH W/T/O UTERUS ABOVE 250 G", "code_information": [{"code": "58544", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LT OFFSET ANGLED LAMINA HK 179752095", "code_information": [{"code": "179752095", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LT OFFSET ANGLED LAMINA HK 188152095", "code_information": [{"code": "188152095", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LT OFFSET UP-ANGLED LAMINA HK 179752096", "code_information": [{"code": "179752096", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LT SIZE 3 FEMORAL CR NONPOROUS 161-3301", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "161-3301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 1680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LT SIZE 7BKS TRIMAX PS FEMORAL NONPOROUS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "165-1701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5200.0, "discounted_cash": 3120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LU GNOTYP BCAM EXON 3", "code_information": [{"code": "196U", "type": "CPT"}], "standard_charges": [{"minimum": 460.94, "maximum": 542.31, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 542.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 460.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUBRICANT DIFFUSER 4EA PK PA700", "code_information": [{"code": "PA700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.1, "discounted_cash": 57.06, "setting": "both", "billing_class": "facility"}]}, {"description": "LUBRICANT OIL DIFFUSER MIDAS REX LEGEND", "code_information": [{"code": "PA-100A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 109.82, "discounted_cash": 65.89, "setting": "both", "billing_class": "facility"}]}, {"description": "LUBRICATING JELLY 120GM TUBE", "code_information": [{"code": "MED0133", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 23.49, "discounted_cash": 14.09, "setting": "both", "billing_class": "facility"}]}, {"description": "LUBRICATING JELLY IN FOIL PACK 2.7 G MDS032273H", "code_information": [{"code": "MDS032273H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.25, "discounted_cash": 0.15, "setting": "both", "billing_class": "facility"}]}, {"description": "LUER ADAPTOR CONF NEEDLE-PK/10 283999001", "code_information": [{"code": "283999001", "type": "CDM"}], "standard_charges": [{"gross_charge": 395.0, "discounted_cash": 237.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LUGOLS 30ML SOLUTION", "code_information": [{"code": "MED0134", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 162.56, "discounted_cash": 97.54, "setting": "both", "billing_class": "facility"}]}, {"description": "LUMBAR PAIN TRAY-LF DYNJ36390A", "code_information": [{"code": "DYNJ36390A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 39.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LUNG FUNCTION TEST (MBC/MVV)", "code_information": [{"code": "94200", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG PERF&VENTILAT DIFERENTL", "code_information": [{"code": "78598", "type": "CPT"}], "standard_charges": [{"minimum": 612.11, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 612.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1229.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1229.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1294.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1164.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 867.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG PERFUSION DIFFERENTIAL", "code_information": [{"code": "78597", "type": "CPT"}], "standard_charges": [{"minimum": 269.94, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 269.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 542.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 542.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 570.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 513.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 382.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG PERFUSION IMAGING", "code_information": [{"code": "78580", "type": "CPT"}], "standard_charges": [{"minimum": 269.94, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 269.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 542.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 542.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 570.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 513.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 382.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT", "code_information": [{"code": "7", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 54.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 59.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 44.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "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": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT DOUBLE", "code_information": [{"code": "32853", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT SINGLE", "code_information": [{"code": "32851", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT WITH BYPASS", "code_information": [{"code": "32852", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT WITH BYPASS", "code_information": [{"code": "32854", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG VENTILAT&PERFUS IMAGING", "code_information": [{"code": "78582", "type": "CPT"}], "standard_charges": [{"minimum": 1292.58, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1292.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2596.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2596.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2732.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2459.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1830.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG VENTILATION IMAGING", "code_information": [{"code": "78579", "type": "CPT"}], "standard_charges": [{"minimum": 581.99, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 581.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1168.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1168.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1230.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1107.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 824.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG VOLUME REDUCTION", "code_information": [{"code": "32491", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LW GNOTYP ICAM4 EXON 1", "code_information": [{"code": "197U", "type": "CPT"}], "standard_charges": [{"minimum": 460.94, "maximum": 542.31, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 542.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 460.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LWR XTR VASC STDY BILAT", "code_information": [{"code": "93924", "type": "CPT"}], "standard_charges": [{"minimum": 1041.99, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1225.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1041.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYME DIS DNA AMP PROBE", "code_information": [{"code": "87476", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 256.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 514.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 514.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 541.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 487.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 363.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 102.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 87.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYME DIS DNA DIR PROBE", "code_information": [{"code": "87475", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 164.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 329.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 329.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 347.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 312.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 232.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 58.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 49.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYME DISEASE ANTIBODY", "code_information": [{"code": "86617", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 98.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 198.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 198.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 208.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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"maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 93.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 187.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 187.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 197.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 177.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 132.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 49.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 42.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPH CHORIOMENINGITIS AB", "code_information": [{"code": "86727", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 66.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 134.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 134.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 141.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 127.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 94.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 37.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 32.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPH SYSTEM IMAGING", "code_information": [{"code": "78195", "type": "CPT"}], "standard_charges": [{"minimum": 850.62, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 850.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1708.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1708.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1798.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1618.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1204.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY ARM/LEG", "code_information": [{"code": "75801", "type": "CPT"}], "standard_charges": [{"minimum": 903.67, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 903.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1814.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1814.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1910.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1719.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1280.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2532.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2152.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY ARMS/LEGS", "code_information": [{"code": "75803", "type": "CPT"}], "standard_charges": [{"minimum": 903.67, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 903.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1814.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1814.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1910.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1719.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1280.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6512.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5535.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY TRUNK", "code_information": [{"code": "75805", "type": "CPT"}], "standard_charges": [{"minimum": 903.67, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 903.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1814.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1814.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 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11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPHAZURIN 1% (10  mg/mL) (ISOSULFAN BLUE) 5ML", "code_information": [{"code": "MED0135", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1512.09, "discounted_cash": 907.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LYMPHOCYTE CULTURE MIXED", "code_information": [{"code": "86821", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", 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0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 166.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 335.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 798.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 798.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 840.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 389.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 782.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"BCBS PREMIER HMO", "standard_charge_dollar": 552.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 139.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 118.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. 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{"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC", "code_information": [{"code": "840", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24169.89, "maximum": 36169.64, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 36169.64, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 24169.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC", "code_information": [{"code": "824", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16106.9, "maximum": 24945.59, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 24945.59, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16106.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC", "code_information": [{"code": "823", "type": "MS-DRG"}], "standard_charges": [{"minimum": 33210.56, "maximum": 53074.89, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 53074.89, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 33210.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "825", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9975.06, "maximum": 13959.73, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13959.73, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9975.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC", "code_information": [{"code": "842", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8228.87, "maximum": 11930.65, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11930.65, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8228.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYSE CHEST FIBRIN INIT DAY", "code_information": [{"code": "32561", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYSE CHEST FIBRIN SUBQ DAY", "code_information": [{"code": "32562", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYSIS ABDOMINAL ADHESIONS LAPAROSCOPIC 44180", "code_information": [{"code": "44180", "type": "CPT"}, {"code": "1481277", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 10356.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYSIS INTRANASAL SYNECHIA 30560", "code_information": [{"code": "30560", "type": "CPT"}, {"code": "1582406", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYSIS OF ADHESIONS 58740", "code_information": [{"code": "58740", "type": "CPT"}, {"code": "1481278", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYSIS OF EXCISION OF PENILE POST CIRC. ADHESIONS 54162", "code_information": [{"code": "54162", "type": "CPT"}, {"code": "1657191", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "gross_charge": 9591.0, "discounted_cash": 5754.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 5275.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYSIS OF LABIAL ADHESIONS 56441", "code_information": [{"code": "56441", "type": "CPT"}, {"code": "1481279", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Labor Room Delivery, Circumcision", "code_information": [{"code": "723", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 67.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Labor Room Delivery, Delivery Room", "code_information": [{"code": "722", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", 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CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 70.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 73.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 66.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 49.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 12.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 10.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MACS TL POLYAXIAL CLAMP SX800T", "code_information": [{"code": "SX800T", "type": "CDM"}], "standard_charges": [{"gross_charge": 1126.38, "discounted_cash": 675.83, "setting": "both", "billing_class": "facility"}]}, {"description": "MACS TL THORACIC POLYAXIAL CLAMP SX801T", "code_information": [{"code": "SX801T", "type": "CDM"}], "standard_charges": [{"gross_charge": 1126.38, "discounted_cash": 675.83, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO RAD FX SZ1 20MM RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "180416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7600.63, "discounted_cash": 4560.38, "setting": "both", "billing_class": "facility"}]}, {"description": "MAG CTRLD CAPSULE ENDOSCOPY", "code_information": [{"code": "651T", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 7055.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNETIC IMAGE BONE MARROW", "code_information": [{"code": "77084", "type": "CPT"}], "standard_charges": [{"minimum": 1184.24, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1184.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2378.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2378.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2503.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2253.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1677.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNEVIST INJ SOL 5 ML", "code_information": [{"code": "MED0136", "type": "CDM"}, {"code": "255", "type": "RC"}], "standard_charges": [{"gross_charge": 71.92, "discounted_cash": 43.15, "setting": "both", "billing_class": "facility"}]}, {"description": "MAJOR BLADDER PROCEDURES WITH CC", "code_information": [{"code": "654", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21090.02, "maximum": 32008.26, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 32008.26, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 21090.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR BLADDER PROCEDURES WITH MCC", "code_information": [{"code": "653", "type": "MS-DRG"}], "standard_charges": [{"minimum": 40289.26, "maximum": 63227.11, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 63227.11, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 40289.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR BLADDER PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "655", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15246.65, "maximum": 23560.74, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 23560.74, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 15246.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST PROCEDURES WITH CC", "code_information": [{"code": "164", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25010.81, "maximum": 28547.81, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 28547.81, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 25010.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST PROCEDURES WITH MCC", "code_information": [{"code": "163", "type": "MS-DRG"}], "standard_charges": [{"minimum": 47894.3, "maximum": 52277.55, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 52277.55, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 47894.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "165", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13596.62, "maximum": 21141.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 21141.49, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13596.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST TRAUMA WITH CC", "code_information": [{"code": "184", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7372.3, "maximum": 12114.39, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 12114.39, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7372.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST TRAUMA WITH MCC", "code_information": [{"code": "183", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10943.21, "maximum": 18003.16, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 18003.16, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10943.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST TRAUMA WITHOUT CC/MCC", "code_information": [{"code": "185", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5375.08, "maximum": 8820.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 8820.67, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5375.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR ESOPHAGEAL DISORDERS WITH CC", "code_information": [{"code": "369", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8138.59, "maximum": 11541.62, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11541.62, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8138.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR ESOPHAGEAL DISORDERS WITH MCC", "code_information": [{"code": "368", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14268.96, "maximum": 18941.14, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 18941.14, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14268.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "370", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5455.82, "maximum": 7916.72, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7916.72, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5455.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC", "code_information": [{"code": "372", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7621.86, "maximum": 11674.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11674.32, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7621.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC", "code_information": [{"code": "371", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12762.79, "maximum": 19825.82, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 19825.82, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12762.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC", "code_information": [{"code": "373", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5560.78, "maximum": 8227.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 8227.49, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5560.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR HEAD AND NECK PROCEDURES WITH CC", "code_information": [{"code": "141", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24368.29, "maximum": 24368.29, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 24368.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR HEAD AND NECK PROCEDURES WITH MCC", "code_information": [{"code": "140", "type": "MS-DRG"}], "standard_charges": [{"minimum": 47967.59, "maximum": 47967.59, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 47967.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "142", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17834.16, "maximum": 17834.16, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 17834.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC", "code_information": [{"code": "809", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8841.03, "maximum": 14047.07, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 14047.07, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8841.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC", "code_information": [{"code": "808", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15775.13, "maximum": 25976.58, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 25976.58, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 15775.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "810", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6767.48, "maximum": 10795.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10795.32, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6767.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT", "code_information": [{"code": "469", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17807.0, "maximum": 37073.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 37073.6, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 21770.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 34654.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 17807.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 29456.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 34953.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 30904.01, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 25433.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 24161.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 22890.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 21618.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC", "code_information": [{"code": "470", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17807.0, "maximum": 34953.0, "estimated_discounted_cash": 53513.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 21385.34, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 21770.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 34654.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 17807.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 29456.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 34953.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 19372.69, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 25433.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 24161.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 22890.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 21618.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES", "code_information": [{"code": "483", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3870.0, "maximum": 28901.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 28901.68, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 4732.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7533.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 3870.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 6403.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 9144.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 17494.89, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 4699.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR MALE PELVIC PROCEDURES WITH CC/MCC", "code_information": [{"code": "707", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13148.88, "maximum": 22010.29, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 22010.29, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13148.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "708", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10323.71, "maximum": 16814.51, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 16814.51, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10323.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC", "code_information": [{"code": "507", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3870.0, "maximum": 21983.06, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 21983.06, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 4732.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7533.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 3870.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 6403.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 9144.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14257.95, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 4699.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "508", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3870.0, "maximum": 14081.09, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 14081.09, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 4732.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7533.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 3870.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 6403.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 9144.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10623.92, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 4699.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SKIN DISORDERS WITH MCC", "code_information": [{"code": "595", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14583.85, "maximum": 23989.46, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 23989.46, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14583.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SKIN DISORDERS WITHOUT MCC", "code_information": [{"code": "596", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7424.41, "maximum": 12261.84, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 12261.84, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7424.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [{"code": "330", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18521.02, "maximum": 26809.09, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 26809.09, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 18521.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [{"code": "329", "type": "MS-DRG"}], "standard_charges": [{"minimum": 36646.42, "maximum": 52081.33, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 52081.33, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 36646.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "331", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12439.1, "maximum": 18725.64, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 18725.64, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12439.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR THUMB OR JOINT PROCEDURES", "code_information": [{"code": "506", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3870.0, "maximum": 17002.79, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 17002.79, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 4732.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7533.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 3870.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 6403.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 9144.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10351.6, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 4699.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33750", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33755", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33762", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33766", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": 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"CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALARIA ANTIBODY", "code_information": [{"code": "86750", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 228.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 205.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 153.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 38.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 32.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALE SLING SYSTEM ADVANC XP 720163-03", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "720163-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12580.14, "discounted_cash": 7548.08, "setting": "both", "billing_class": "facility"}]}, {"description": "MALECOT CATHETER STERILE 30FR 361230", "code_information": [{"code": "361230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 96.7, "discounted_cash": 58.02, "setting": "both", "billing_class": "facility"}]}, {"description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC", "code_information": [{"code": "436", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8337.51, "maximum": 12790.37, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 12790.37, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8337.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC", "code_information": [{"code": "435", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12461.12, "maximum": 20694.61, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 20694.61, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12461.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC", "code_information": [{"code": "437", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6354.97, "maximum": 8905.74, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 8905.74, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6354.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [{"code": "755", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7853.07, "maximum": 12590.75, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 12590.75, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7853.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [{"code": "754", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13515.88, 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"code_information": [{"code": "723", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8085.01, "maximum": 12735.93, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 12735.93, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8085.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [{"code": "722", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12182.2, "maximum": 19609.18, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 19609.18, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12182.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, 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{"description": "MALIGNANT BREAST DISORDERS WITH MCC", "code_information": [{"code": "597", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12624.8, "maximum": 19924.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 19924.49, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12624.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANT BREAST DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "599", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5258.38, "maximum": 9696.28, "estimated_discounted_cash": 10072.45, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9696.28, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5258.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALLEOLAR REDUCTION FORCEPS 5882000050", "code_information": [{"code": "5882000050", "type": "CDM"}], "standard_charges": [{"gross_charge": 680.96, "discounted_cash": 408.58, "setting": "both", "billing_class": "facility"}]}, {"description": "MALLET 648.003", "code_information": [{"code": "648.003", "type": "CDM"}], "standard_charges": [{"gross_charge": 1812.24, "discounted_cash": 1087.34, "setting": "both", "billing_class": "facility"}]}, {"description": "MALYUGIN RING MANIPULATOR", "code_information": [{"code": "MAL-0003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 438.9, "discounted_cash": 263.34, "setting": "both", "billing_class": "facility"}]}, {"description": "MAMBO DRILL BIT", "code_information": [{"code": "CS 1863", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 395.0, "discounted_cash": 237.0, "setting": "both", 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"standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee 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"CDM"}], "standard_charges": [{"gross_charge": 302.6, "discounted_cash": 181.56, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER 8360912 PEDICLE CONICAL WITH CYL 8360912", "code_information": [{"code": "8360912", "type": "CDM"}], "standard_charges": [{"gross_charge": 302.6, "discounted_cash": 181.56, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER FEMUR REGISTRATION ROBOTIC SURGICAL SYSTEM", "code_information": [{"code": "403405", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 142.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER REFLECTIVE 3 SPHERE FLEXIBLE DISP", "code_information": [{"code": "41773", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.88, "discounted_cash": 29.93, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SKIN DUAL TIPINK TIME OUT SLEEVE AND RULER FOURIN ONE PEN W/ TIME OUT SLE", "code_information": [{"code": "1041-NNS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.31, "discounted_cash": 4.99, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SKIN REGTIP BARRL W RULER&LBL 250GPRL", "code_information": [{"code": "250GPRL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.69, "discounted_cash": 2.81, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SKIN SURGICAL DUAL TIP 9 LABEL RULER PERMANENT INK", "code_information": [{"code": "1422SRL9-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.05, "discounted_cash": 3.03, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SPHERES PULSE PASSIVE  5050156", "code_information": [{"code": "5050156", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 221.2, "discounted_cash": 132.72, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SURG GENTIAN VIOLET SKIN STANDARD TIP W/ FLEXIBLE RULER DEVON STRL", "code_information": [{"code": "31145785", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.79, "discounted_cash": 2.87, "setting": "both", "billing_class": "facility"}]}, {"description": "MARS 2 BLADE USAGE CODE 999.198", "code_information": [{"code": "999.198", "type": "CDM"}], "standard_charges": [{"gross_charge": 1736.64, "discounted_cash": 1041.98, "setting": "both", "billing_class": "facility"}]}, {"description": "MARS ANTERIOR RETRACTOR USAGE CODE 999.101", "code_information": [{"code": "999.101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1736.64, "discounted_cash": 1041.98, "setting": "both", "billing_class": "facility"}]}, {"description": "MARS POSTERIOR CERVICAL RETRACTOR USAGE CODE 999.132", "code_information": [{"code": "999.132", "type": "CDM"}], "standard_charges": [{"gross_charge": 2026.08, "discounted_cash": 1215.65, "setting": "both", "billing_class": "facility"}]}, {"description": "MARSUPIALIZATION ODON CYST", "code_information": [{"code": "D7509", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 2566.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST 56440", "code_information": [{"code": "56440", "type": "CPT"}, {"code": "1481284", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MARSUPIALIZATION OF URETHRAL DIVERTICULUM MALE OR FEMALE 53240", "code_information": [{"code": "53240", "type": "CPT"}, {"code": "42635451", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAS PLIF LIGHT CABLE - STERILE 3400044", "code_information": [{"code": "3400044", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1172.26, "discounted_cash": 703.36, "setting": "both", "billing_class": "facility"}]}, {"description": "MAS PLIF MODULE 8200220", "code_information": [{"code": "8200220", "type": "CDM"}], "standard_charges": [{"gross_charge": 4351.0, "discounted_cash": 2610.6, "setting": "both", "billing_class": "facility"}]}, {"description": "MAS TLIF DISPOSABLE MODULE 8200200", "code_information": [{"code": "8200200", "type": "CDM"}], "standard_charges": [{"gross_charge": 4454.89, "discounted_cash": 2672.93, "setting": "both", "billing_class": "facility"}]}, {"description": "MAS TLIF HOOP SHIM MODULE 8200202", "code_information": [{"code": "8200202", "type": "CDM"}], "standard_charges": [{"gross_charge": 3132.32, "discounted_cash": 1879.39, "setting": "both", "billing_class": "facility"}]}, {"description": "MAS TLIF HOOP SHIM NON-STERILE   DISPOSABLE 3400014", "code_information": [{"code": "3400014", "type": "CDM"}], "standard_charges": [{"gross_charge": 990.72, "discounted_cash": 594.43, "setting": "both", "billing_class": "facility"}]}, {"description": "MAS TLIF LIGHT CABLE   SELF RETAINING 3400033", "code_information": [{"code": "3400033", "type": "CDM"}], "standard_charges": [{"gross_charge": 1172.26, "discounted_cash": 703.36, "setting": "both", "billing_class": "facility"}]}, {"description": "MAS TLIF LIGHT CABLE AND HOOP SHIM MODULE 8200201", "code_information": [{"code": "8200201", "type": "CDM"}], "standard_charges": [{"gross_charge": 4084.24, "discounted_cash": 2450.54, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK  LARYNGEAL SUP AIRWAY STERILE SZ 3 ALBF030SU", "code_information": [{"code": "ALBF030SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.4, "discounted_cash": 31.44, "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": 56.89, "discounted_cash": 34.13, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK  SURGICAL FOG FREE FOAM", "code_information": [{"code": "AT71235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.45, "discounted_cash": 0.27, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ADULT OXYGEN WITH VENT NONREBREATHER 001362", "code_information": [{"code": "1362", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 6.71, "discounted_cash": 4.03, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK AEROSOL 22MM CLR ELONGATED ADJ NOSECLIP SOFT VINYL LF PEDI", "code_information": [{"code": "1085", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.71, "discounted_cash": 1.63, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK AEROSOL 22MM TUBING FACE TENT LIGHTWEIGHT FOR AEROSOL THERAPY LF ADLT", "code_information": [{"code": "HCS4632", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.53, "discounted_cash": 4.52, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANES 4 SM SWTDRM AR CSH ADJ INFL VLV TRDRP SHP SCNT", "code_information": [{"code": "1242", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.29, "discounted_cash": 6.17, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANES BUBBLE GUM SCENTED CUSHION CASE OF 50 MASKS SWEET DREAMS PEDI", "code_information": [{"code": "1145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.01, "discounted_cash": 4.81, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANES SZ 4 BUBBLEGUM CHERRY AND STRAWBERRY SCENTED SWEET DREAMS PEDI", "code_information": [{"code": "1443", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.93, "discounted_cash": 5.36, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANES TRINITY LARGE ADULT SZ 6", "code_information": [{"code": "SH20668", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.94, "discounted_cash": 7.76, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANESTHESIA ADULT SZ6 DISP TIGER LARGE", "code_information": [{"code": "SH20661", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.47, "discounted_cash": 6.28, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANESTHESIA INFLATABLE ULTRA LARGE ADLT.", "code_information": [{"code": "FM-KM200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.7, "discounted_cash": 7.02, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANESTHESIA SZ 4 BUBBLE GUM SCENTED CUSHION SWEET DREAMS PEDI", "code_information": [{"code": "1142", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.94, "discounted_cash": 10.16, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANESTHESIA SZ 6 LG NASAL ORAL WITHOUT STRP ADLT DISP", "code_information": [{"code": "1065", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.08, "discounted_cash": 4.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK BETHESDA VELCRO EKM-SMFM1064", "code_information": [{"code": "EKM-SMFM1064", "type": "CDM"}], "standard_charges": [{"gross_charge": 87.72, "discounted_cash": 52.63, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK BREATHING MED CONCENTRATION ELONGATED ANESTHESIA LF PEDI", "code_information": [{"code": "1042", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.36, "discounted_cash": 2.02, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK CARDINAL HEALTH FLEXIBLE ANESTHESIA CHILD/SMALL ADULT SIZE 4 1071004", "code_information": [{"code": "1071004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.52, "discounted_cash": 6.91, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK CONFORT DISP", "code_information": [{"code": "A-70310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 124.8, "discounted_cash": 74.88, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK CPAP LARGE HEADGEAR 989805634991", "code_information": [{"code": "9.90E+11", "type": "CDM"}], "standard_charges": [{"gross_charge": 86.99, "discounted_cash": 52.19, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ELONGATED ADULT HUD1083", "code_information": [{"code": "A7015", "type": "HCPCS"}, {"code": "HUD1083", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.85, "discounted_cash": 1.11, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK EYE BLUE GEL", "code_information": [{"code": "ASSI-A42343", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.39, "discounted_cash": 8.63, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE 100ML 2ML PER HOUR LARYNGEAL MASK AIRWAY PUMP PAINCARE", "code_information": [{"code": "10314", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 478.01, "discounted_cash": 286.81, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE BEACH CHAIR CRITTER W/ SIDE-SQUEEZE BUCKLE EKM-CFM10559", "code_information": [{"code": "EKM-CFM10559", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.72, "discounted_cash": 52.63, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE CLR TENT UNDER THE CHIN DESIGN VINYL FOR HIGH HUMIDITY AEROSOL THERAPY", "code_information": [{"code": "1388", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.65, "discounted_cash": 3.99, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE DISPOSABLE BETHESDA", "code_information": [{"code": "10601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.98, "discounted_cash": 47.99, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE POSITIONER LF DISP", "code_information": [{"code": "BF047", "type": "CDM"}], "standard_charges": [{"gross_charge": 89.91, "discounted_cash": 53.95, "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": 92.37, "discounted_cash": 55.42, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE RESPIRATORY MD LG SECURE-GARD N95 LF FLUID RESPIRATOR CONE", "code_information": [{"code": "N95-ML", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.14, "discounted_cash": 1.88, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE SZ 2 BUBBLE GUM SCENTED SWEET DREAMS LF PEDI DISP", "code_information": [{"code": "1122", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.75, "discounted_cash": 5.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE SZ 2 ORANGE SOFT CUSHIONINFLTBLINFANT ANESTHESIA BREATHING PEDI", "code_information": [{"code": "1022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.18, "discounted_cash": 4.91, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE SZ 3 SOFT CUSHIONINFLATABLE TODDLER ANESTHESIA BREATHING PEDI", "code_information": [{"code": "1032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.6, "discounted_cash": 9.36, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE SZ 3 TODDLER BUBBLE GUM SCENT SWEET DREAMS PEDI", "code_information": [{"code": "1132", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.38, "discounted_cash": 5.03, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL ESOPHAGEAL DISP SIZE 2.5 M0372", "code_information": [{"code": "M0372", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.26, "discounted_cash": 19.96, "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": 52.4, "discounted_cash": 31.44, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SZ 1 NEO/INFANT LF ALAA010SU", "code_information": [{"code": "ALAA010SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.26, "discounted_cash": 19.96, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SZ 1.5 INFANT LF ALAA015SU", "code_information": [{"code": "ALAA015SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.26, "discounted_cash": 19.96, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SZ 2.5 CHILD LF", "code_information": [{"code": "ALAA025SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.26, "discounted_cash": 19.96, "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": 32.34, "discounted_cash": 19.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SZ 4 ADULT LF ALAA040SU", "code_information": [{"code": "ALAA040SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.43, "discounted_cash": 20.06, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SZ 5 ADULT LF ALAA050SU", "code_information": [{"code": "ALAA050SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.26, "discounted_cash": 19.96, "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": 52.43, "discounted_cash": 31.46, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK O2 ADULT CLR MED W/ 7FT TU", "code_information": [{"code": "1041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.87, "discounted_cash": 1.72, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK O2 HIGH CONCENTRATION NON REBREATHER THREEIN ONE W/ SAFETY VENTS AND 7FT TU", "code_information": [{"code": "1203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.09, "discounted_cash": 1.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK O2 VNYL ADLT ELNG NREB TBG FLP VLV LF DISP 7FT", "code_information": [{"code": "1061", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1174.92, "discounted_cash": 704.95, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYGEN 3 IN 1 STYLE ADULT COMP U-CONNECT 001361", "code_information": [{"code": "1361", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.25, "discounted_cash": 2.55, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYGEN MEDIUM-CONCENTRATION 7 SC RHO41U", "code_information": [{"code": "RHO41U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.33, "discounted_cash": 2.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYGEN MEDIUM-CONCENTRATION 7SC RH041U", "code_information": [{"code": "RH041U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.71, "discounted_cash": 1.63, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYGEN MEDN ELONGATED ADULT 3280RHO41U", "code_information": [{"code": "3280RHO41U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.72, "discounted_cash": 1.63, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYGEN NON REBREATHING ELONGATED ADLT DISP", "code_information": [{"code": "1059", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.31, "discounted_cash": 2.59, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYGEN NON-REBREATHER PEDIATRIC", "code_information": [{"code": "1058", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.71, "discounted_cash": 4.03, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK PROC PLEATED EARLOOPS YELLOW 47117", "code_information": [{"code": "47117", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.29, "discounted_cash": 0.17, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK PROCEDURE INSTA GARD BLUE W/WRA AT7511-WE", "code_information": [{"code": "AT7511-WE", "type": "CDM"}], "standard_charges": [{"gross_charge": 1.86, "discounted_cash": 1.12, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK PROCEDURE SECURE GARD BLUE AT71021", "code_information": [{"code": "AT71021", "type": "CDM"}], "standard_charges": [{"gross_charge": 0.26, "discounted_cash": 0.16, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK RESP N95 NIOSH APPROVED SMALL 1860S", "code_information": [{"code": "1860S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.14, "discounted_cash": 1.88, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK SURG DUCKBILL FOGFREE ANTIGLAR", "code_information": [{"code": "AT54635-I", "type": "CDM"}], "standard_charges": [{"gross_charge": 2.71, "discounted_cash": 1.63, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK SURG SPECIALTY PLEATED SPLASH RESISTANT SENSITIVE SKIN W/ TIES", "code_information": [{"code": "1072835", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.76, "discounted_cash": 1.06, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK TENT W/OXY TUBE", "code_information": [{"code": "1221", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.25, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK TRACHEOSTOMY ADJ STRP WITHOUT TUBING ADLT", "code_information": [{"code": "1075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.54, "discounted_cash": 2.12, "setting": "both", "billing_class": "facility"}]}, {"description": "MASS SPECTROMETRY QUAL/QUAN", "code_information": [{"code": "83789", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 92.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 184.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 184.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 194.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 175.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 130.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 70.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAST RAD URBAN TYPE", "code_information": [{"code": "19306", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAST RADICAL", "code_information": [{"code": "19305", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY", "code_information": [{"code": "19162", "type": "CPT"}, {"code": "1481285", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY FOR MALIGNANCY WITH CC/MCC", "code_information": [{"code": "582", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11520.13, "maximum": 19862.11, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 19862.11, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11520.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "583", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10115.25, "maximum": 18631.5, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 18631.5, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10115.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY MODIFIED RADICAL 19307", "code_information": [{"code": "19307", "type": "CPT"}, {"code": "1481286", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 10329.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY PARTIAL 19301", 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SODIUM CHLOR INJ 0.9% 100 ML 2B1307", "code_information": [{"code": "2B1307", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.7, "discounted_cash": 4.62, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SPONGE SURGIFOAM ABSORABLE GELATIN 1972", "code_information": [{"code": "1972", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.84, "discounted_cash": 14.3, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-STAPLER  ECHELON FLEX  POWERED  ENDO PLEE60A", "code_information": [{"code": "PLEE60A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 887.0, "discounted_cash": 532.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-STAPLER HEAD FIXED 35 REG STRL DISP PXR35", "code_information": [{"code": "PXR35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.42, "discounted_cash": 22.45, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-STAPLER HEAD FIXED 35 WIDE STRL DISP PXW35", "code_information": [{"code": "PXW35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.84, "discounted_cash": 34.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-STAPLER SKIN MULTIFIRE PREMIUM 35 059037", "code_information": [{"code": "59037", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.78, "discounted_cash": 100.07, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-STAPLER SKIN ROTATING HEAD 35 WIDE PRW35", "code_information": [{"code": "PRW35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 103.2, "discounted_cash": 61.92, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-STAPLR SKIN PROXIMTE PLUS MD WIDE 35 PMW35", "code_information": [{"code": "PMW35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.61, "discounted_cash": 16.57, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-STPLR PWR ECHELON FLEX STANDARD 45MM PSEE45A", "code_information": [{"code": "PSEE45A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 770.97, "discounted_cash": 462.58, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUPPORTER ATHLETIC ADLT LG 39 INCH- 44 INCH", "code_information": [{"code": "202636S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.32, "discounted_cash": 22.99, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SURGIWAND II 5MM CAUT L-HOOK TBE GFS 178093", "code_information": [{"code": "178093", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 445.57, "discounted_cash": 267.34, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTRE ENDO STITCH PLYSRB VIOLT 2-O 4 170053", "code_information": [{"code": "170053", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 205.55, "discounted_cash": 123.33, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTURE 0 8-18 CTD VIC UND BR CT- J840D", "code_information": [{"code": "J840D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.91, "discounted_cash": 31.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTURE 3-0 BLACK BRAIDED 12-18 A184H", "code_information": [{"code": "A184H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.61, "discounted_cash": 5.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTURE 4/0 27 CHROMIC GUT RB-1 U203H", "code_information": [{"code": "U203H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.47, "discounted_cash": 24.28, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTURE 5/0 18 CHROMIC GUT BL S-1 1792G", "code_information": [{"code": "1792G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.03, "discounted_cash": 38.42, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTURE ENDOSTITCH PLYSRB VIOLT O 48 170052", "code_information": [{"code": "170052", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 205.55, "discounted_cash": 123.33, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTURE PRMA-HAND 2/0 12-30 BKL BRAID A305H", "code_information": [{"code": "A305H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.9, "discounted_cash": 6.54, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-SUTURE PRMA-HAND 3/0 12-30 BLK 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"discounted_cash": 53.53, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-TOURNIQUET DISPOSABLE 24 5921-024-135", "code_information": [{"code": "5921-024-135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 103.06, "discounted_cash": 61.84, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-TRAY FOLEY 16FR LUBRISIL AND STTLCK 947316", "code_information": [{"code": "947316", "type": "CDM"}], "standard_charges": [{"gross_charge": 31.14, "discounted_cash": 18.68, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-VLOC 180 ABSORBABLE 2-0 ESTCH 8 LP VLOCA208L", "code_information": [{"code": "VLOCA208L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 310.8, "discounted_cash": 186.48, "setting": "both", "billing_class": "facility"}]}, {"description": "MBO-WINGSET 21X.75 12\"COLLECT BLD PU 367352", "code_information": [{"code": "367352", "type": 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"billing_class": "facility"}]}, {"description": "MCHNL FRAGILITY RBC PRFLG", "code_information": [{"code": "123U", "type": "CPT"}], "standard_charges": [{"minimum": 890.09, "maximum": 1047.23, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1047.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 890.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MCOLN1 GENE", "code_information": [{"code": "81290", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 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8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MD CERTIFICATION HHA PATIENT", "code_information": [{"code": "G0180", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MD INR TEST REVIE INTER MGMT", "code_information": [{"code": "G0250", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MD RECERTIFICATION HHA PT", "code_information": [{"code": "G0179", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MD SERVICE REQUIRED FOR PMD", "code_information": [{"code": "G0372", "type": 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SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MDI WIRE GUIDE SIZE 3-4 MDWGLG", "code_information": [{"code": "MDWGLG", "type": "CDM"}], "standard_charges": [{"gross_charge": 1352.16, "discounted_cash": 811.3, "setting": "both", "billing_class": "facility"}]}, {"description": "MEAS LUNG VOL THRU 2 YRS", "code_information": [{"code": "94013", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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"BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEASURE CARD 8114506 X10 4.75 8114506", "code_information": [{"code": "8114506", "type": "CDM"}], "standard_charges": [{"gross_charge": 794.65, "discounted_cash": 476.79, "setting": "both", "billing_class": "facility"}]}, {"description": "MEASURE KIDNEY PRESSURE", "code_information": [{"code": "50396", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASURE POST VOIDING RESIDUAL URINE/BLADDER BY ULTRASOUND NON IMAGE 51798", "code_information": [{"code": "51798", "type": "CPT"}, {"code": "1643977", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 14483.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASURE URETER PRESSURE", "code_information": [{"code": "50686", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASURE VENOUS PRESSURE", "code_information": [{"code": "93770", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEATOTOMY 53020", "code_information": [{"code": "53020", "type": "CPT"}, {"code": "1481297", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECH REMOV TUNNELED CV CATH", "code_information": [{"code": "36595", "type": "CPT"}], "standard_charges": [{"minimum": 3004.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECH REMOV TUNNELED CV CATH", "code_information": [{"code": "36596", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": 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"case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECHANICAL CHEST WALL OSCILL", "code_information": [{"code": "94669", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECKELS DIVERT EXAM", "code_information": [{"code": "78290", "type": "CPT"}], "standard_charges": [{"minimum": 374.43, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 374.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 530.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECP2 FULL GENE ANALYSIS", "code_information": [{"code": "234U", "type": "CPT"}], "standard_charges": [{"minimum": 1313.81, "maximum": 1545.76, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1545.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1313.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE DUP/DELET VARIANT", "code_information": [{"code": "81304", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 551.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1107.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1107.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1165.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1049.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 781.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 439.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 373.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE FULL SEQ", "code_information": [{"code": "81302", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1024.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2058.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2058.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2166.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1949.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1451.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1545.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1313.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE KNOWN VARIANT", "code_information": [{"code": "81303", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 351.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 298.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED NUTRITION INDIV SUBSEQ", "code_information": [{"code": "97803", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED PHYSIC DOS EVAL RAD EXPS", "code_information": [{"code": "76145", "type": "CPT"}], "standard_charges": [{"minimum": 588.95, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 588.95, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 834.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2116.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1798.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED SERV 10PM-8AM 24 HR FAC", "code_information": [{"code": "99053", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No 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"BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENB-4C VACC 2 DOSE IM", "code_information": [{"code": "90620", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENB-FHBP VACC 2/3 DOSE IM", "code_information": [{"code": "90621", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENISCAL CINCH II", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1695.0, "discounted_cash": 1017.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MENISCAL REPAIR DEVICE AIR ALL-INSIDE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1785.0, "discounted_cash": 1071.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MENISCAL REPAIR DEVICE W/3 IMPLANTS MR003C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MR003C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1608.69, "discounted_cash": 965.21, "setting": "both", "billing_class": "facility"}]}, {"description": "MENISCAL SYSTEM CURVED DOWN AIR  4723", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4723", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1380.0, "discounted_cash": 828.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC", "code_information": [{"code": "760", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6398.28, "maximum": 11178.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11178.68, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6398.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "761", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4032.6, "maximum": 7189.69, "estimated_discounted_cash": 22181.41, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7189.69, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4032.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEPERIDINE 25MG/ML INJ", "code_information": [{"code": "MED0400", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.02, "discounted_cash": 6.61, "setting": "both", "billing_class": "facility"}]}, {"description": "MEPILEX BORDER AG ANTIMICROBIAL DRESSINGS 4\"X10\" 498450", "code_information": [{"code": "498450", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 103.38, "discounted_cash": 62.03, "setting": "both", "billing_class": "facility"}]}, {"description": "MEPILEX BORDER SACRUM DRESSING 6.3\"X7.9\" 282055", "code_information": [{"code": "282055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.66, "discounted_cash": 19.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MEPIVACAINE 1%/CARBOCAINE 30ML", "code_information": [{"code": "MED0137", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 27.15, "discounted_cash": 16.29, "setting": "both", "billing_class": "facility"}]}, {"description": "MEPIVACAINE 1.5%/CARBOCAINE 30ML", "code_information": [{"code": "MED0138", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 41.24, "discounted_cash": 24.74, "setting": "both", "billing_class": "facility"}]}, {"description": "MEPIVACAINE 2%/ CARBOCAINE (PF) 20ML", "code_information": [{"code": "MED0590", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 27.67, "discounted_cash": 16.6, "setting": "both", "billing_class": "facility"}]}, {"description": "MEPIVACAINE 3% INJ DENTAL CARTRIDGES 1.7 ML", "code_information": [{"code": "MED0643", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.49, "discounted_cash": 3.29, "setting": "both", "billing_class": "facility"}]}, {"description": "MERCAPTOPURINE 50 MG", "code_information": [{"code": "S0108", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MESH          ANGLED IMPACTOR E905-825", "code_information": [{"code": "E905-825", "type": "CDM"}], "standard_charges": [{"gross_charge": 1028.73, "discounted_cash": 617.24, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH          CUTTER 9059105 CUTTER 9059105", "code_information": [{"code": "9059105", "type": "CDM"}], "standard_charges": [{"gross_charge": 5517.07, "discounted_cash": 3310.24, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH          DISPOSABLE 9059104 CUTTER BLADE 9059104", "code_information": [{"code": "9059104", "type": "CDM"}], "standard_charges": [{"gross_charge": 304.15, "discounted_cash": 182.49, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH          IMPACTOR E905-820", "code_information": [{"code": "E905-820", "type": "CDM"}], "standard_charges": [{"gross_charge": 1028.73, "discounted_cash": 617.24, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH          PYRACUTTER HOLDER 905-836", "code_information": [{"code": "905-836", "type": "CDM"}], "standard_charges": [{"gross_charge": 1186.23, "discounted_cash": 711.74, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH          SYN CUTTER 397.091", "code_information": [{"code": "397.091", "type": "CDM"}], "standard_charges": [{"gross_charge": 3916.08, "discounted_cash": 2349.65, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH          TRIMMER E905-830", "code_information": [{"code": "E905-830", "type": "CDM"}], "standard_charges": [{"gross_charge": 1671.8, "discounted_cash": 1003.08, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH  SELF-GRIPPING POLYPROPYLENE PP3020G PP3020G", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PP3020G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2496.76, "discounted_cash": 1498.06, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH 10CM X 15CM MONOFIL POLY W/ ABS POLY ACID GRIP ABS COLL FILM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "LPG1510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 897.75, "discounted_cash": 538.65, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH 15X15CM PP1515G", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PP1515G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1336.89, "discounted_cash": 802.13, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH 20X15CM PP2015G", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PP2015G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1537.41, "discounted_cash": 922.45, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH 30X30CM SLF FIXATE FLATPP3030G", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PP3030G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2944.4, "discounted_cash": 1766.64, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH 5.5 X 3.5 PARIETEX PROGRIP LEFT", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "TEM1409GL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1021.8, "discounted_cash": 613.08, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH 5.5 X 3.5 PARIETEX PROGRIP RIGHT", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "TEM1409GR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1021.8, "discounted_cash": 613.08, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH ABDOMINAL WALL 30 CM X 30 CM PARTIALLY ABSORBL LIGHTWEIGHT ULTRAPRO", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "UML1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1042.32, "discounted_cash": 625.39, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH BAG ENVELOPE TYRX NEURO ABSORABLE NMRM6133", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "NMRM6133", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2506.0, "discounted_cash": 1503.6, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH COMPOSITE 12CM ROUND OPTIMIZED PARIETEX", "code_information": [{"code": "PCO12X", "type": "CDM"}], "standard_charges": [{"gross_charge": 1422.72, "discounted_cash": 853.63, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH COMPOSITE 20DEG 12CM SYMBOTEX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "SYM2012E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2127.66, "discounted_cash": 1276.6, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH FIRM 20 CM X 20 CM STRATTICE", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "2020002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18856.0, "discounted_cash": 11313.6, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH FLEXBAND 0.3 X 16 STRIP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "31052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5324.1, "discounted_cash": 3194.46, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH HERNIA 16 X 12CM LEFT PROGRIP SELF FIXATING", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "LPG1612AL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1519.53, "discounted_cash": 911.72, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH HERNIA 16 X 12CM PROGRIP FLAT SHEET", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "LPG1612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 817.95, "discounted_cash": 490.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH HERNIA 3IN X 6IN PARTIALLY ABSORBABLY REPAIR ULTRAPRO", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "UMR3", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 574.41, "discounted_cash": 344.65, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH HERNIA 5.3IN X 3.1IN LFT MED LIGHT WT LG PORE BARD 3DMAX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "117310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 279.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH HERNIA 6IN X 6IN PARTIALLY ABSORBABLY REPAIR ULTRAPRO", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "UMM3", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 568.03, "discounted_cash": 340.82, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH HERNIA PROLENE 4CM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "phse6", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1149.95, "discounted_cash": 689.97, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH HERNIA SYMBOTEX 25 X 15 MONOFILAMENT ABSORB COLLAGEN/ MARKING", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "SYM2515E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3108.01, "discounted_cash": 1864.81, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH KNOTLESS INCONTINENCE KIM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "KIM-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2604.0, "discounted_cash": 1562.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH LARGE LEFT 3DMAX MID 0116311", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "116311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1179.9, "discounted_cash": 707.94, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH LEVEL ONE CMF STANDARD ORTHOG STRIP 2.0MM SCREW 34 X 2 HOLES 117MM 00-105-49-09", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-105-49-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 940.8, "discounted_cash": 564.48, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH LEVEL ONE CMF STANDARD ORTHOG STRIP 2.0MM SCREW 34 X 2 HOLES 117MM T=0.6MM CP TITANIUM 00-100-6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-100-63-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 628.5, "discounted_cash": 377.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH MERIDIAN VPS RESTORELLE Y CONTOUR POLYPROPYLENE  52081", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "52081", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3304.6, "discounted_cash": 1982.76, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH OPEN BIOINDCTIVE IMPLANT 1 LARGE 2999-3", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "2999-3", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6240.0, "discounted_cash": 3744.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH OVITEX IHR BIOSCAFFOLD W/ PERMANENT POLYMER (PP) 10X17CM F10243-1017I", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "F10243-1017I", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH PARIETEX PGRECT HERNIA 30X15CM TEM3015G", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "TEM3015G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 351.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH PARIETEX RECTANGULAR 15X15CM TEM1515G", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "TEM1515G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 279.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH PHASIX ST UMBILICAL HERNIA PATCH 4.3 CM  1.7 SMALL 1230007", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "1230007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1980.0, "discounted_cash": 1188.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH PHASIX ST UMBILICAL HERNIA PATCH 6.4 CM  2.5 MED 1230008", 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{"code": "PCDM1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1939.86, "discounted_cash": 1163.92, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH PROCEED VENTRAL PATCH MD CIR 2.5 PVPM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PVPM", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1035.0, "discounted_cash": 621.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH PROCEED VENTRAL PATCH SM CIR 1.7 PVPS", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "PVPS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1105.08, "discounted_cash": 663.05, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH PROGRIP 20 X 15CM TEM2015G", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "TEM2015G", "type": "CDM"}, {"code": "278", "type": "RC"}], 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"standard_charges": [{"gross_charge": 5448.9, "discounted_cash": 3269.34, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH TISSUE SEPARATING PHYSIOMESH OPEN 20 X 30CM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "OPHY2030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5804.84, "discounted_cash": 3482.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH TISSUE SEPARATING PHYSIOMESH OPEN 25 X 37.5CM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "OPHY2536", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7640.93, "discounted_cash": 4584.56, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH ULTRAPRO 10CM X 15CM ADVANCED", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "UPA31015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 522.84, "discounted_cash": 313.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH ULTRAPRO POLYPROYLENE NONABSORBABLE PLUG SM 3CM X 5CM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "UPPS2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 809.49, "discounted_cash": 485.69, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH VENTRALIGHT ST W ECHO 11CM CIRCLE", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "5990011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4009.2, "discounted_cash": 2405.52, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH VICRYL KNITTED 6X6 VKMM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "VKMM", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1249.78, "discounted_cash": 749.87, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH WITH ECHO 2 POSITIONING SYSTEM 20CM / 8\" CIRCLE VENTRALIGHT ST 5990020", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "5990020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5941.0, "discounted_cash": 3564.6, "setting": "both", "billing_class": "facility"}]}, {"description": "MESHSYMBOTEX 17 X 10 CM ELLIPTICAL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "SYM1710E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1321.02, "discounted_cash": 792.61, "setting": "both", "billing_class": "facility"}]}, {"description": "METAL HEMI AWL 03-6000-13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3-6000-13", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2002.32, "discounted_cash": 1201.39, "setting": "both", "billing_class": "facility"}]}, {"description": "METAL HEMI CRUCIATE PUNCH 03-6000-11", "code_information": [{"code": "3-6000-11", "type": "CDM"}], "standard_charges": [{"gross_charge": 2002.32, "discounted_cash": 1201.39, "setting": "both", "billing_class": "facility"}]}, {"description": "METAL HEMI CUT GUIDE 03-6000-14", "code_information": [{"code": "3-6000-14", "type": "CDM"}], "standard_charges": [{"gross_charge": 2002.32, "discounted_cash": 1201.39, "setting": "both", "billing_class": "facility"}]}, {"description": "METAL HEMI DECOMPRESSION CUT GUIDE 03-6000-15", "code_information": [{"code": "3-6000-15", "type": "CDM"}], "standard_charges": [{"gross_charge": 2002.32, "discounted_cash": 1201.39, "setting": "both", "billing_class": "facility"}]}, {"description": "METAL TAPE GAUGE 03.661.010", "code_information": [{"code": "3.661.010", "type": "CDM"}], "standard_charges": [{"gross_charge": 7138.8, "discounted_cash": 4283.28, "setting": "both", "billing_class": "facility"}]}, {"description": "METATARSECTOMY 28140", "code_information": [{"code": "28140", "type": "CPT"}, {"code": "1481300", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METER ASTHMA 2.25IN X 6IN PEAK FLOW 1-WAY VALVE ASTHMACHECK DISP", "code_information": [{"code": "2068", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.43, "discounted_cash": 26.06, "setting": "both", "billing_class": "facility"}]}, {"description": "METHA LIQUID CLEANER APPLICATOR F/CONE ND619", "code_information": [{"code": "ND619", "type": "CDM"}], "standard_charges": [{"gross_charge": 145.6, "discounted_cash": 87.36, "setting": "both", "billing_class": "facility"}]}, {"description": "METHA LIQUID CLEANER APPLICATOR F/CONE ND622", "code_information": [{"code": "ND622", "type": "CDM"}], "standard_charges": [{"gross_charge": 237.0, "discounted_cash": 142.2, "setting": "both", "billing_class": "facility"}]}, {"description": "METHADONE ORAL 5MG", "code_information": [{"code": "S0109", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METHERGINE 0.2 MG/ML INECTION", "code_information": [{"code": "MED0234", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 80.07, "discounted_cash": 48.04, "setting": "both", "billing_class": "facility"}]}, {"description": "METHYLENE BLUE 1% 10 MG/1 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"standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 55.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 110.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 110.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 116.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 104.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 78.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHYLERGONOVINE (METHERGINE) 0.2MG/ML", "code_information": [{"code": "MED0341", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 69.81, "discounted_cash": 41.89, "setting": "both", "billing_class": "facility"}]}, {"description": "METHYLPHENIDATE", "code_information": [{"code": "80360", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHYLPREDNISOLONE (DEPO-MEDROL) 40MG 1ML", "code_information": [{"code": "MED0142", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 36.16, "discounted_cash": 21.7, "setting": "both", "billing_class": "facility"}]}, {"description": "METHYLPREDNISOLONE (SOLU-MEDROL) 125MG/2ML VIAL", "code_information": [{"code": "MED0144", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 21.76, "discounted_cash": 13.06, "setting": "both", "billing_class": "facility"}]}, {"description": "METYRAPONE PANEL", "code_information": [{"code": "80436", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 606.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1218.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1218.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1282.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1154.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 859.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", 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[{"code": "698.605S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2160.0, "discounted_cash": 1296.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MIS INSTRUMENTS KIT", "code_information": [{"code": "KITANCMIS", "type": "CDM"}], "standard_charges": [{"gross_charge": 2052.0, "discounted_cash": 1231.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MIS POSTERIOR SITE PREP SET USAGE MPSPINSTPU", "code_information": [{"code": "MPSPINSTPU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1944.0, "discounted_cash": 1166.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MISC Implant", "code_information": [{"code": "45923974", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "MISCELLANEOUS DISORDERS OF NUTRITION, 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MITOCHONDRIAL ANTIBODY EACH", "code_information": [{"code": "86381", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, 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[{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MODULUS XLW 12X22X60MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1221260P2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MODULUS XLW, 10X22X50MM 10DEGREES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1221050P2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MODULUS XLW10X22X50MM 10 DEGREES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1221055P2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MODULUS-C 9 X 15 X 12MM 7DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6793004P2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4407.0, "discounted_cash": 2644.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MOG-IGG1 ANTB CBA EACH", "code_information": [{"code": "86362", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 106.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 214.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 214.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 225.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 203.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 151.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 35.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 29.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOG-IGG1 ANTB FLO CYTMTRY EA", "code_information": [{"code": "86363", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 466.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 935.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 935.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 985.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 886.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 660.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 110.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 93.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOHS 1 STAGE H/N/HF/G", "code_information": [{"code": "17311", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOHS ADDL STAGE", "code_information": [{"code": "17312", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOHS ADDL STAGE T/A/L", "code_information": [{"code": "17314", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOHS SURG ADDL BLOCK", "code_information": [{"code": "17315", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 804.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 684.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 6", "code_information": [{"code": "81405", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 920.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 685.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 882.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 750.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 7", "code_information": [{"code": "81406", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 828.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 704.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 8", "code_information": [{"code": "81407", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5856.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4977.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MORPHINE 10MG/ML 1ML", "code_information": [{"code": "MED0366", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.59, "discounted_cash": 6.35, "setting": "both", "billing_class": "facility"}]}, {"description": "MORPHINE 10MG/ML PF INJ. 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{"description": "MPACT FLAT LINER HC 32/J 01.32.3256HCT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1.32.3256HCT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6500.0, "discounted_cash": 3900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MPL GENE COMMON VARIANTS", "code_information": [{"code": "81338", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee 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"plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 807.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 601.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 440.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 374.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MPL GENE SEQ ALYS EXON 10", "code_information": [{"code": "81339", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 526.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1057.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1057.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1113.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1002.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 746.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 542.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 460.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MPSV4 VACCINE SUBQ", "code_information": [{"code": "90733", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR ANGIO PELVIS W/O & W/DYE", "code_information": [{"code": "72198", "type": "CPT"}], "standard_charges": [{"minimum": 727.21, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 727.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1460.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1460.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1537.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1383.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1030.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR ANGIO SPINE W/O&W/DYE", "code_information": [{"code": "72159", "type": "CPT"}], "standard_charges": [{"minimum": 1085.71, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1085.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2180.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2180.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2295.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2065.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1537.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR ELASTOGRAPHY", "code_information": [{"code": "76391", "type": "CPT"}], "standard_charges": 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"standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1287.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2586.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2586.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2722.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2450.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1824.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR SPECTROSCOPY", "code_information": [{"code": "76390", "type": "CPT"}], "standard_charges": [{"minimum": 813.59, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1634.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1634.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1720.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1548.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1152.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR safety determination by a physician or other qualified health care professional responsible for the safety of the MR procedure, including review of implant MR conditions for indicated MR examination, analysis of risk vs clinical benefit of performing M", "code_information": [{"code": "76016", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data 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"methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], 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"plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1882.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3781.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3781.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", 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{"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 19209.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 18142.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC", "code_information": [{"code": "59", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8068.86, "maximum": 13878.07, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13878.07, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8068.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC", "code_information": [{"code": "58", "type": "MS-DRG"}], 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"95805", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MULTIPOLAR BIPOLAR CUP SHELL 51MM O.D.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "-5001-051-00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1590.0, "discounted_cash": 954.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MUPIROCIN 2% 22GM OINTMENT/ 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"standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 78.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 156.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 156.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 164.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 148.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 110.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 54.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 46.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MURILUBE 2ML", "code_information": [{"code": "MED0151", "type": "CDM"}], "standard_charges": [{"gross_charge": 136.78, "discounted_cash": 82.07, "setting": "both", "billing_class": "facility"}]}, {"description": "MUSC TEST DONE W/N TEST COMP", "code_information": [{"code": "95886", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST 2 LIMBS", "code_information": [{"code": "95861", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST 4 LIMBS", "code_information": [{"code": "95864", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3242.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY L-S SPINE", "code_information": [{"code": "72265", "type": "CPT"}], "standard_charges": [{"minimum": 1198.77, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1198.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2407.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2407.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2534.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2280.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1698.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3242.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62302", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62303", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY NECK SPINE", "code_information": [{"code": "72240", "type": "CPT"}], "standard_charges": [{"minimum": 767.97, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 767.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1542.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1542.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1623.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1461.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1087.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3242.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY THORACIC SPINE", "code_information": [{"code": "72255", "type": "CPT"}], "standard_charges": [{"minimum": 992.74, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 992.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1993.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1993.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2098.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1888.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1406.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3242.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC", "code_information": [{"code": "827", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16527.48, "maximum": 26765.99, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 26765.99, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16527.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC", "code_information": [{"code": "826", "type": "MS-DRG"}], "standard_charges": [{"minimum": 36317.59, "maximum": 54163.72, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 54163.72, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 36317.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "828", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12003.84, "maximum": 18180.09, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 18180.09, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12003.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC", "code_information": [{"code": "829", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22825.2, "maximum": 34976.46, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 34976.46, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 22825.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "830", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10413.99, "maximum": 16587.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 16587.67, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10413.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOCARDIAL IMAGING MCG", "code_information": [{"code": "541T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYOCARDIAL IMAGING MCG I&R", "code_information": [{"code": "542T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYOCRD CONTRAST PRFUJ ECHO", "code_information": [{"code": "439T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 4173.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 1 STD W/CT", "code_information": [{"code": "78429", "type": "CPT"}], "standard_charges": [{"minimum": 1277.93, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1277.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2566.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2566.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2701.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2431.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1810.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 1STD RST/STRS", "code_information": [{"code": "78491", "type": "CPT"}], "standard_charges": [{"minimum": 1389.95, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1389.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2791.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2791.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2938.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2644.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1968.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 2RTRACER", "code_information": [{"code": "78432", "type": "CPT"}], "standard_charges": [{"minimum": 1993.07, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1993.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4002.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 4002.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4213.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3792.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2823.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 2RTRACER CT", "code_information": [{"code": "78433", "type": "CPT"}], "standard_charges": [{"minimum": 2435.87, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2435.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4892.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 4892.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 5149.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 4634.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 3450.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET MLT RST&STRS", "code_information": [{"code": "78492", "type": "CPT"}], "standard_charges": [{"minimum": 2964.98, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2964.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5955.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 5955.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6268.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5641.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4199.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET RST&STRS CT", "code_information": [{"code": "78431", "type": "CPT"}], "standard_charges": [{"minimum": 1993.07, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1993.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4002.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 4002.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4213.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3792.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2823.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET RST/STRS W/CT", "code_information": [{"code": "78430", "type": "CPT"}], "standard_charges": [{"minimum": 1277.93, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1277.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2566.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2566.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2701.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2431.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1810.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET SINGLE STUDY", "code_information": [{"code": "78459", "type": "CPT"}], "standard_charges": [{"minimum": 1976.65, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1976.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3970.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3970.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4178.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3761.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2799.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD STRAIN IMG SPCKL TRCK", "code_information": [{"code": "93356", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", 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"standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOSURE TISSUE POLYP DEVISE", "code_information": [{"code": "30-401LITE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MYOSURE TISSUE REMOVAL DEVICE", "code_information": [{"code": "10-401FC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2561.57, "discounted_cash": 1536.94, "setting": "both", 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYRINGOTOMY LASER-ASSIST", "code_information": [{"code": "S2225", "type": "HCPCS"}], "standard_charges": [{"minimum": 3070.0, "maximum": 6491.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"code_information": [{"code": "9210584", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 284.4, "setting": "both", "billing_class": "facility"}]}, {"description": "NASAL/ENDOSCOPY DIAGNOSTIC UNILATERAL/BILATERAL (SEPARATE PROCEDURE) 31231", "code_information": [{"code": "31231", "type": "CPT"}, {"code": "1582419", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURGICAL W/CONCHA BULLOSA RESECTION 31240", "code_information": [{"code": "31240", "type": "CPT"}, {"code": "1582418", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 14275.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURGICAL W/DILATION FRONTAL SINUS OSTINUM 31296", "code_information": [{"code": "31296", "type": "CPT"}, {"code": "1635701", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 14275.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURGICAL W/DILATION SPHENOID SINUS OSTIUM 31297", "code_information": [{"code": "31297", "type": "CPT"}, {"code": "1635702", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 14275.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NB RESUSCITATION", "code_information": [{"code": "99465", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NCNTC IFR SPCTRSC O/T PAD 1", "code_information": [{"code": "640T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NCNTC R-T FLUOR WND IMG EA", "code_information": [{"code": "599T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 4173.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NDL 23G 5FR WILLIAMS INJ", "code_information": [{"code": "G14220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.85, "discounted_cash": 55.11, "setting": "both", "billing_class": "facility"}]}, {"description": "NDL INSJ W/O NJX 1 OR 2 MUSC", "code_information": [{"code": "20560", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NDL OCULOELECTROMYOGRAPHY 1+", "code_information": [{"code": "92265", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NDLE 18GX3.5 PINK HUB STRL SNGL USE 405184", "code_information": [{"code": "405184", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.69, "discounted_cash": 7.61, "setting": "both", "billing_class": "facility"}]}, {"description": "NDOVAG CRYG RF REMDL TISS", "code_information": [{"code": "672T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NDSC HRV UXTR ART 1 SGM CAB", "code_information": [{"code": "33509", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEBULIZER MICRO MIST NEBULIZER ONLY 1880", "code_information": [{"code": "1880", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.28, "discounted_cash": 1.37, "setting": "both", "billing_class": "facility"}]}, {"description": "NEBULIZER PT 500CC BRIGHT YELLOW RING LG VOLUME EMPTY VENTURY STYLE ENTRAINMENT", "code_information": [{"code": "1770", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.44, "discounted_cash": 4.46, "setting": "both", "billing_class": "facility"}]}, {"description": "NEBULIZER PT 6CC 90DEG SM VOLUME EASY SEAL THREADED CAP HND HELD ORIN LINE W/ 7F", "code_information": [{"code": "1883", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.14, "discounted_cash": 1.88, "setting": "both", "billing_class": "facility"}]}, {"description": "NECK TRIAL ADAPTER", "code_information": [{"code": "1601-2000", "type": "CDM"}], "standard_charges": [{"gross_charge": 318.05, "discounted_cash": 190.83, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE  8MM MEGA SUTURECUT IS5000 ENG 471309", "code_information": [{"code": "471309", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5955.12, "discounted_cash": 3573.07, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE #5 FORCE FIBER 38 STRAND", "code_information": [{"code": "3910-900-050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 132.95, "discounted_cash": 79.77, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 10G X 5IN BEVELED 283902510", "code_information": [{"code": "283902510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 426.6, "discounted_cash": 255.96, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 10G X 5IN DIAMOND 283903510", "code_information": [{"code": "283903510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 426.6, "discounted_cash": 255.96, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 11G JAMSHIDI  DJ6011X", "code_information": [{"code": "DJ6011X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.96, "discounted_cash": 48.58, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 11G W DIAMOND TIP ACCESS 310-0019", "code_information": [{"code": "310-0019", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 665.0, "discounted_cash": 399.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 11G X 11CM BONE MARROW HARVEST/ACCESS", "code_information": [{"code": "74066-01M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 569.77, "discounted_cash": 341.86, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 15G 24MM-48MM ADJ LENGTH DISP DIN1515X", "code_information": [{"code": "DIN1515X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.99, "discounted_cash": 33.59, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 18G DISP BIOPSY TRUPATH", "code_information": [{"code": "8031258", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.2, "discounted_cash": 180.12, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 18G X 12CM NAVIGUIDE PCNL ACCESS M0067001320", "code_information": [{"code": "M0067001320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 157.37, "discounted_cash": 94.42, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 18G X 12CM NAVIGUIDE PCNL ACCESS M0067001330", "code_information": [{"code": "M0067001330", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 157.37, "discounted_cash": 94.42, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 20GX3.5YELLOWHUBSTRL SNGLUSE 405182", "code_information": [{"code": "405182", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.35, "discounted_cash": 6.21, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 20GX6 INSULATED EXT SET 30 DEG 4894278", "code_information": [{"code": "4894278", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.95, "discounted_cash": 41.97, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 21G SONOTAP 6\"", "code_information": [{"code": "1185-3F150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.24, "discounted_cash": 43.34, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 22G 8\" SPINAL W/18G 5\" INTODUCER", "code_information": [{"code": "183110 Needle", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13211.67, "discounted_cash": 7927.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 22GX5 BLACK LONG STRL SINGLE USE 405148", "code_information": [{"code": "405148", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.8, "discounted_cash": 18.48, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 22GX7 BLACK LONG STRL SINGLE 405149", "code_information": [{"code": "405149", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.8, "discounted_cash": 18.48, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 25GX4.69BLUELONG STRLSNGLUSE 405234", "code_information": [{"code": "405234", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.13, "discounted_cash": 15.08, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 30GX5MM PEN AUTOSHIELD 100 BX 329515", "code_information": [{"code": "329515", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.83, "discounted_cash": 1.7, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 31G X 5 MM PEN  MPHPN315Z", "code_information": [{"code": "MPHPN315Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.74, "discounted_cash": 0.44, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 36MM RECSE CUTTING 1/2 CIRCLE W/LOOP AR-7280", "code_information": [{"code": "AR-7280", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 133.12, "discounted_cash": 79.87, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 4IN EPIDURAL 1114", "code_information": [{"code": "1114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 187.2, "discounted_cash": 112.32, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 5CM 20GA HOMER J CURVE WIRE 231050G", "code_information": [{"code": "231050G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.19, "discounted_cash": 52.91, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 7.5CM 20GA HOMER 2 J CURVE BREAST  231075G", "code_information": [{"code": "231075G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.19, "discounted_cash": 52.91, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ACCESS 10GA IVAS", "code_information": [{"code": "306-530-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 733.28, "discounted_cash": 439.97, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ACCESS 11GA X 15 CM HARVEST", "code_information": [{"code": "RAN-1115", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 278.08, "discounted_cash": 166.85, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ACCESS HARVEST NO PORTS 11GA X 15 CM", "code_information": [{"code": "RAN-1115N", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 181.7, "discounted_cash": 109.02, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ACCESS HIP 17GA PRESERVATION SYSTEM", "code_information": [{"code": "HSP-NDL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 182.24, "discounted_cash": 109.34, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ACCESS INSUFFLATION 14G VERSA S100000", "code_information": [{"code": "S100000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 121.53, "discounted_cash": 72.92, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ACCESS INSUFFLATION 14G VERSASTEP VS150000", "code_information": [{"code": "VS150000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.23, "discounted_cash": 34.94, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ANESTHESIA 25GA X 3.5IN BLUE SPINAL STRL DISP", "code_information": [{"code": "405180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.87, "discounted_cash": 5.32, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ANESTHESIA REINFORCED 27G RAN-027-5", "code_information": [{"code": "RAN-027-5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.57, "discounted_cash": 195.34, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ASPIRATION BONE MAROW", "code_information": [{"code": "74174-15M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 517.64, "discounted_cash": 310.58, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ASPIRATION BONE MARROW", "code_information": [{"code": "93-0800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 382.36, "discounted_cash": 229.42, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ASPIRATION W/ BEVEL TIP STYLET", "code_information": [{"code": "91-8300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 382.36, "discounted_cash": 229.42, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ATKINSON RETROBULBAR 25G X 1.5\" STRAIGHT 111637", "code_information": [{"code": "111637", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.94, "discounted_cash": 10.16, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY 11GA X 6IN BONE MARROW", "code_information": [{"code": "DBMNJ1106TL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.17, "discounted_cash": 102.1, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY 11GA X 6IN BONE MARROW ILLINOIS STERNAL LLIAC JAMSHIDI LF", "code_information": [{"code": "710DJ6011X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.37, "discounted_cash": 39.82, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY 11GA X 6IN BONE MARROW TAPERED TROCAR TIP JAMSHIDI", "code_information": [{"code": "TJM6011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.22, "discounted_cash": 10.33, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY 13GA X 2IN ASPIRATION BONE MARROW ILLINOIS STERNAL LLIAC ADJ DEPTH", "code_information": [{"code": "DJ2013X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.88, "discounted_cash": 52.13, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY 18GA 3.5 CMINTRAOSSEOUSINFUSION ILLINOIS LANCET POINT BONE MARROW", "code_information": [{"code": "DIN1518X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.99, "discounted_cash": 33.59, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY 18GA X 6 SOFT TISSUE TRU CUT", "code_information": [{"code": "2N2713X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.2, "discounted_cash": 46.92, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY CHEST LINING", "code_information": [{"code": "32400", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY LYMPH NODES", "code_information": [{"code": "38505", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY MAGNUM 18G X 25CM MN1825", "code_information": [{"code": "MN1825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.56, "discounted_cash": 49.54, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY MAGNUM LATEX FREE STERILE DISPOSABLE PINK 18GA X 20CM", "code_information": [{"code": "MN1820", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.56, "discounted_cash": 56.74, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY TRU-CUT 20MM SPECIMEN NOTCH SCALPEL SHARP SURG STEEL CUTTING EDGE", "code_information": [{"code": "2N2704X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.18, "discounted_cash": 48.71, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BLADDER INJECTION 70CM", "code_information": [{"code": "NB1070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 178.88, "discounted_cash": 107.33, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BLADE PLASMA PEEK PLASMABLADEINSTR", "code_information": [{"code": "PS200-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1231.58, "discounted_cash": 738.95, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BLOCK 18GA 50MM X 2IN TUOHY BEVELINSTR", "code_information": [{"code": "PL18050TGC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 144.98, "discounted_cash": 86.99, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BLUNT FILL W FILTER 18GX1.5 F-BFN18G151", "code_information": [{"code": "F-BFN18G151", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.86, "discounted_cash": 0.52, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BONE MARROW ASPIRATION 8 GAUGE X 15CM", "code_information": [{"code": "74174-01M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 731.5, "discounted_cash": 438.9, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BONE MARROW ASPIRATION MC-RAN-11C", "code_information": [{"code": "MC-RAN-11C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3458.0, "discounted_cash": 2074.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BONEE 22G 5F 4MM 70CM FLEX AND RIGID NBI070", "code_information": [{"code": "NBI070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 124.8, "discounted_cash": 74.88, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BONEE RIDGID 6FR 4MM TIP 35CM LENGTH", "code_information": [{"code": "NB1035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.84, "discounted_cash": 122.3, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BOTOX INJECTION NBI035", "code_information": [{"code": "NBI035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 178.88, "discounted_cash": 107.33, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BRACHYTHERAPY 17G X 20CM PRE-WAXED W/GOLD MARKER GM1233-1720", "code_information": [{"code": "GM1233-1720", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.06, "discounted_cash": 0.04, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BULLET-TIP IMBIBE 8G X 6IN", "code_information": [{"code": "2090-0029", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 741.69, "discounted_cash": 445.01, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE CERCLAGE PASSING SINGLE USE", "code_information": [{"code": "AR-7816", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.42, "discounted_cash": 195.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE DBM 22GA X 1ININSULATED W/ EXTENSION SET FOR STIMYPLEX NERVE STIMULATOR S", "code_information": [{"code": "333691", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.67, "discounted_cash": 34.6, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE DELIVERY 12GA X 10CM", "code_information": [{"code": "DLS-7123-01S", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT SINGLE STRAND HAND OR FOOT;MORE THAN 4 CM IN LENGTH 64891", "code_information": [{"code": "64891", "type": "CPT"}, {"code": "1481344", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT SINGLE STRAND HAND OR FOOT;UP TO 4 CM IN LENGTH 64890", "code_information": [{"code": "64890", "type": "CPT"}, {"code": "1481345", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY FASCIAL GRAFT", "code_information": [{"code": "15840", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY MICROSURG GRAFT", "code_information": [{"code": "15842", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY MUSCLE GRAFT", "code_information": [{"code": "15841", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PEDICLE TRANSFER", "code_information": [{"code": "64907", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE 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"standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURECTOMY POPLITEAL", "code_information": [{"code": "27326", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"description": "NEURO ALZHEIMER MRNA 24 GEN", "code_information": [{"code": "289U", "type": "CPT"}], "standard_charges": [{"minimum": 1891.53, "maximum": 2225.47, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2225.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1891.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ALZHEIMER QUAN IMAGING", "code_information": [{"code": "207U", "type": "CPT"}], "standard_charges": [{"minimum": 1272.3, "maximum": 1496.92, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1496.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1272.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ASD MEAS 14 ACYL CARN", "code_information": [{"code": "322U", "type": "CPT"}], "standard_charges": [{"minimum": 1866.64, "maximum": 2196.19, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2196.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1866.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ASD MEAS 16 C METBLT", "code_information": [{"code": "263U", "type": "CPT"}], "standard_charges": [{"minimum": 1866.64, "maximum": 2196.19, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2196.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1866.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ASD RNA 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"code_information": [{"code": "35U", "type": "CPT"}], "standard_charges": [{"minimum": 1346.43, "maximum": 1584.14, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1584.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1346.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO INH ATAXIA DNA 12 COM", "code_information": [{"code": "216U", "type": "CPT"}], "standard_charges": [{"minimum": 3825.4, "maximum": 4500.77, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 4500.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3825.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO INH ATAXIA DNA 51 GENE", "code_information": [{"code": "217U", "type": "CPT"}], "standard_charges": [{"minimum": 5471.37, "maximum": 6437.33, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6437.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5471.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO MUSC DYS DMD SEQ ALYS", "code_information": [{"code": "218U", "type": "CPT"}], "standard_charges": [{"minimum": 5672.09, "maximum": 6673.48, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6673.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5672.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROELTRD STIM POST TIBIAL", "code_information": [{"code": "64566", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROENDOSCOPY ADD-ON", "code_information": [{"code": "62160", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG GRAM NEG", "code_information": [{"code": "142U", "type": "CPT"}], 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[{"minimum": 497.77, "maximum": 585.65, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 585.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 497.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACTERAL VAGINOSIS RNA VAGINAL-FLUID ALG 81513", "code_information": [{"code": "81513", "type": "CPT"}, {"code": "46129166", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "gross_charge": 428.0, "discounted_cash": 256.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 125.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 252.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 252.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 265.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 239.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 178.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 417.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 354.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BCT QUAN ANTMCRB SC", "code_information": [{"code": "311U", "type": "CPT"}], "standard_charges": [{"minimum": 20.1, "maximum": 23.65, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 23.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 20.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BCT/VIRAL TRAIL IP10", "code_information": [{"code": "351U", "type": "CPT"}], "standard_charges": [{"minimum": 648.36, "maximum": 762.83, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 762.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 648.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV&VAGINITIS AMP PRB", "code_information": [{"code": "352U", "type": "CPT"}], "standard_charges": [{"minimum": 354.99, "maximum": 417.66, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 417.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 354.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV&VAGINITIS DNA ALG", "code_information": [{"code": "81514", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 770.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 654.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS CHRNC HCV 6 ASSAYS", "code_information": [{"code": "81596", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 305.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 613.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 613.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 645.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 580.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 432.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 211.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 179.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS DNA UNTRGT NGNRJ SEQ", "code_information": [{"code": "152U", "type": "CPT"}], "standard_charges": [{"minimum": 5291.79, "maximum": 6226.05, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6226.05, "methodology": "fee schedule"}, 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"methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD VAGUS NRV", "code_information": [{"code": "64408", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AUTOL WBC CONCENTRATE", "code_information": [{"code": "481T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee 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"methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14607.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 11708.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11123.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10537.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND 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billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14607.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 11708.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11123.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10537.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 9952.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CAR CTH SLCTV RV/RA ANG", "code_information": [{"code": "93566", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14607.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 11708.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11123.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10537.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 9952.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CAR CTH SPRVLV AORTGRPHY", "code_information": [{"code": "93567", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 14607.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14607.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 11708.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11123.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10537.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 9952.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CATH SLCT P ANGRPH MAPCA", "code_information": [{"code": "93575", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CATH SLCT P-ART ANGRP BI", "code_information": [{"code": "93573", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CATH SLCT PULM VN ANGRPH", "code_information": [{"code": "93574", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CGEN CAR CATH SLCTV OPAC", "code_information": [{"code": "93564", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 14607.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14607.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 11708.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11123.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10537.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 9952.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CGEN CAR CTH SLCTV C ANG", "code_information": [{"code": "93563", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 14607.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14607.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 11708.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11123.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10537.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 9952.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CHEMONUCLEOLYSIS LMBR", "code_information": [{"code": "62292", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CNTRST KNE ARTHG/CT/MRI", "code_information": [{"code": "27369", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX CTH SLCT P-ART ANGRP UNI", "code_information": [{"code": "93569", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX NONCMPND SCLRSNT 1 VEIN", "code_information": [{"code": "36465", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX NONCMPND SCLRSNT MLT VN", "code_information": [{"code": "36466", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "214T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "215T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "216T", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "217T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "218T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case 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"methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PX NFROSGRM &/URTRGRM", "code_information": [{"code": "50431", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3330.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4892.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6688.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6336.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4717.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX PX ONLY MAM DUCTO/GLCTO", "code_information": [{"code": "19030", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT 1 INCMPTNT VEIN", "code_information": [{"code": "36470", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT MLT INCMPTNT VN", "code_information": [{"code": "36471", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX STM CL PRDCT ANL SFT TIS", "code_information": [{"code": "748T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NK CELLS TOTAL COUNT", "code_information": [{"code": "86357", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 73.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 146.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 146.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 154.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 139.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 103.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 110.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 93.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO 5. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 13MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5363.93, "discounted_cash": 3218.36, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 7. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 11MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-711", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5363.93, "discounted_cash": 3218.36, "setting": "both", "billing_class": "facility"}]}, {"description": "NOCARDIA ANTIBODY", "code_information": [{"code": "86744", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 66.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 134.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 134.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 141.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 127.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 94.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 46.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 39.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON RIMMED SPEED PIN 65MM STERILE 74013480", "code_information": [{"code": "74013480", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.22, "discounted_cash": 36.13, "setting": "both", "billing_class": "facility"}]}, {"description": "NON STRL VISIONAIRE LT CUT BLK KIT LGNP", "code_information": [{"code": "V0200022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1064.0, "discounted_cash": 638.4, "setting": "both", "billing_class": "facility"}]}, {"description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC", "code_information": [{"code": "98", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13582.67, "maximum": 24604.2, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 24604.2, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13582.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC", "code_information": [{"code": "97", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25975.53, "maximum": 40656.53, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 40656.53, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 25975.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC", "code_information": [{"code": "99", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9343.09, "maximum": 15802.81, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 15802.81, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9343.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-BLIND INTERATRIAL SHUNT", "code_information": [{"code": "C9760", "type": "HCPCS"}], "standard_charges": [{"minimum": 4173.0, "maximum": 63075.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 63075.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56768.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-CANNULATED TAP   4.0MM 5526067", "code_information": [{"code": "5526067", "type": "CDM"}], "standard_charges": [{"gross_charge": 395.0, "discounted_cash": 237.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NON-CANNULATED TAP   4.75MM 5526068", "code_information": [{"code": "5526068", "type": "CDM"}], "standard_charges": [{"gross_charge": 395.0, "discounted_cash": 237.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NON-EMER TRANSPORT WAIT TIME", "code_information": [{"code": "T2007", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-EXTENSIVE BURNS", "code_information": [{"code": "935", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13371.28, "maximum": 13371.28, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 56.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 38.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13371.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [{"code": "988", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12427.35, "maximum": 19462.87, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 19462.87, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12427.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [{"code": "987", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24461.28, "maximum": 39727.62, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 39727.62, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 24461.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "989", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7638.74, "maximum": 13105.68, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13105.68, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7638.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-IMAGING HEART FUNCTION", "code_information": [{"code": "78414", "type": "CPT"}], "standard_charges": [{"minimum": 51.33, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 51.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 103.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 103.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 108.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 97.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 72.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-LOCKING SCREW FOR USE WITH DISTAL VOLAR RADIUS PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PRCST3518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 324.0, "discounted_cash": 194.4, "setting": "both", "billing_class": "facility"}]}, {"description": "NON-MALIGNANT BREAST DISORDERS WITH CC/MCC", "code_information": [{"code": "600", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7017.04, "maximum": 10849.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10849.76, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7017.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "601", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4544.93, "maximum": 6799.53, "estimated_discounted_cash": 32253.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6799.53, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4544.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-NEEDLED TIPPED BLACK/WHITE 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 557.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 414.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6277.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5335.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NORMAL NEWBORN", "code_information": [{"code": "795", "type": "MS-DRG"}], "standard_charges": [{"minimum": 555.0, "maximum": 4773.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2945.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3182.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 4534.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4773.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 4296.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 3198.0, "methodology": "per diem"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 1353.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 555.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 819.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 737.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NOS QUANT SENSORY TEST", "code_information": [{"code": "110T", "type": "CPT"}], "standard_charges": [{"minimum": 32.59, "maximum": 68.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 65.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 65.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 68.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 62.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOSE ALLERGY TEST", "code_information": [{"code": "95065", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOVASURE ABLATION DEVICE NSV5US-001", "code_information": [{"code": "NSV5US-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2592.0, "discounted_cash": 1555.2, "setting": "both", "billing_class": "facility"}]}, {"description": "NOVASURE ADVANCED SURESOUND KIT", "code_information": [{"code": "NS2013KITUS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2248.56, 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC MED&INF DCMPRN", "code_information": [{"code": "31293", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": 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5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC MED/INF DCMPRN", "code_information": [{"code": "31292", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG ON DCMPRN", "code_information": [{"code": "31294", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": 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"CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINUS ENDOSCOPY SURG DCR", "code_information": [{"code": "31239", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINUS NDSC CRYOABLTJ PNN", "code_information": [{"code": "31243", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee 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"standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRAOP HIPEC PX EA ADD 30MIN", "code_information": [{"code": "96548", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRAPX C FFR W/3D FUNCJL MAP", "code_information": [{"code": "523T", 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1630.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2505.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2129.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTSTY MODUL RAD TX DLVR SMPL", "code_information": [{"code": "77385", "type": "CPT"}], "standard_charges": [{"minimum": 1151.04, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2190.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1630.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2505.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2129.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUBHVL XM PHY/QHP EA ADDL HR", "code_information": [{"code": "96121", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUBHVL XM PHYS/QHP 1ST HR", "code_information": [{"code": "96116", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR EXAM OF TEAR FLOW", "code_information": [{"code": "78660", "type": "CPT"}], "standard_charges": [{"minimum": 425.43, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 425.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 854.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 854.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 899.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 809.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 602.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR MATRIX PROTEIN 22", "code_information": [{"code": "86386", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 130.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 262.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 262.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 276.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 248.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 185.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 63.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 54.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX INTRA-ARTERIAL", "code_information": [{"code": "79445", "type": "CPT"}], "standard_charges": [{"minimum": 473.46, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 473.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 950.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 950.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1001.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 900.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 670.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1093.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 929.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX INTRA-ARTICULAR", "code_information": [{"code": "79440", "type": "CPT"}], "standard_charges": [{"minimum": 128.79, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 128.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 258.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 258.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 272.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 245.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 182.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1093.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 929.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX INTRACAV ADMIN", "code_information": [{"code": "79200", "type": "CPT"}], "standard_charges": [{"minimum": 670.29, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 670.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1346.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1346.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1417.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1275.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 949.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1093.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 929.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX IV ADMIN", "code_information": [{"code": "79101", "type": "CPT"}], "standard_charges": [{"minimum": 929.06, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 929.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1866.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1866.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1964.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1767.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1316.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1093.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 929.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX ORAL ADMIN", "code_information": [{"code": "79005", "type": "CPT"}], "standard_charges": [{"minimum": 528.86, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 528.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1062.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1062.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1118.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1006.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 749.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1093.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 929.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEUS SZ 1 SIMPLICITI SHOULDER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWG401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11494.6, "discounted_cash": 6896.76, "setting": "both", "billing_class": "facility"}]}, {"description": "NUCLEUS SZ 2 SIMPLICITI SHOULDER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWG402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11052.6, "discounted_cash": 6631.56, "setting": "both", "billing_class": "facility"}]}, {"description": "NUCLEUS SZ 3 SIMPLICITI SHOULDER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWG403", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11052.6, "discounted_cash": 6631.56, "setting": "both", "billing_class": "facility"}]}, {"description": "NUCLR RX INTERSTIT COLLOID", "code_information": [{"code": "79300", "type": "CPT"}], "standard_charges": [{"minimum": 189.32, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": 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7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 20 Minutes", "code_information": [{"code": "99324", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", 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DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 45 Minutes", "code_information": [{"code": "99326", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 75 Minutes", "code_information": [{"code": "99328", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Home Visit, Typically 45 Minutes", "code_information": [{"code": "99343", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Office Or Other Outpatient Visit, Typically 10 Minutes", "code_information": [{"code": "99201", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Nicotine 83887", "code_information": [{"code": "80323", "type": "CPT"}, {"code": "20385555", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "gross_charge": 199.0, "discounted_cash": 119.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 47.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 47.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 49.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 44.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 33.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "No implantable/insertable device used with device-intensive procedures C1890", "code_information": [{"code": "C1890", "type": "HCPCS"}, {"code": "45664336", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "Noncontact Near-Infrared Spectroscopy Study Of Flap Or Wound, Image Acquisition Only", "code_information": [{"code": "641T", "type": "CPT"}], "standard_charges": [{"minimum": 126.36, "maximum": 148.67, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 148.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 126.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Noninvasive determination of absolute quantitation of myocardial blood flow (AQMBF), derived from augmentative algorithmic analysis of the dataset acquired via contrast cardiac magnetic resonance (CMR), pharmacologic stress, with interpretation and report", "code_information": [{"code": "899T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Noninvasive ear/pulse ox for o2 sat continuous overnight monitoring 94762", "code_information": [{"code": "94762", "type": "CPT"}, {"code": "1915667", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "gross_charge": 223.0, "discounted_cash": 133.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Noninvasive ear/pulse ox for o2 sat single 94760", "code_information": [{"code": "94760", "type": "CPT"}, {"code": "1915668", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "gross_charge": 171.0, "discounted_cash": 102.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Noninvasive estimate of absolute quantitation of myocardial blood flow (AQMBF), derived from assistive algorithmic analysis of the dataset acquired via contrast cardiac magnetic resonance (CMR), pharmacologic stress, with interpretation and report by a ph", "code_information": [{"code": "900T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Nsl/sins cryo post nasal tis", "code_information": [{"code": "C9771", "type": "HCPCS"}], "standard_charges": [{"minimum": 4173.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Nuclear Medicine Study Of Red Blood Cell, Red Cell Survival, Organ Specific", "code_information": [{"code": "78135", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Nuclear Medicine, Diagnostic", "code_information": [{"code": "341", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Nuclear Medicine, Diagnostic Radiopharmaceuticals", "code_information": [{"code": "343", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 67.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Nuclear Medicine, General Classification", "code_information": [{"code": "340", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Nuclear Medicine, Other", "code_information": [{"code": "349", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Nuclear Medicine, Therapeutic", "code_information": [{"code": "342", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Nuclear Medicine, Therapeutic Radiopharmaceuticals", "code_information": [{"code": "344", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 67.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Nursery General", "code_information": [{"code": "170", "type": "RC"}], "standard_charges": [{"minimum": 548.0, "maximum": 1066.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 670.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1066.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 548.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 906.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 941.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Nursery Newborn Level I", "code_information": [{"code": "171", "type": "RC"}], "standard_charges": [{"minimum": 548.0, "maximum": 1066.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 670.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1066.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 548.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 906.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 941.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Nursery Newborn Level IV", "code_information": [{"code": "174", "type": "RC"}], "standard_charges": [{"minimum": 2440.0, "maximum": 4749.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 2984.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 4749.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 2440.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4037.0, "methodology": "per diem"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 3486.0, "methodology": "per diem"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 3312.0, "methodology": "per diem"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 3137.0, "methodology": "per diem"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 2963.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Nursery Other", "code_information": [{"code": "179", "type": "RC"}], "standard_charges": [{"minimum": 548.0, "maximum": 1066.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 670.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1066.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 548.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 906.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 941.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Nursing Facility Annual Assessment, Typically 30 Minutes", "code_information": [{"code": "99318", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES FOR OBESITY WITH CC", "code_information": [{"code": "620", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11954.0, "maximum": 28245.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 18113.17, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 14615.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 23267.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 11954.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 19777.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 28245.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13282.46, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 17075.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 16221.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 15368.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 14514.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES FOR OBESITY WITH MCC", "code_information": [{"code": "619", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11954.0, "maximum": 30923.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 30923.96, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 14615.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 23267.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 11954.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 19777.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 28245.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 21437.94, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 17075.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 16221.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 15368.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 14514.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC", "code_information": [{"code": "621", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11584.72, "maximum": 28245.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 16579.74, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 14615.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 23267.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 11954.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 19777.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 28245.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11584.72, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 17075.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 16221.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 15368.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 14514.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC", "code_information": [{"code": "940", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15960.83, "maximum": 23947.5, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 23947.5, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 15960.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC", "code_information": [{"code": "939", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24065.66, "maximum": 35999.51, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 35999.51, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 24065.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC", "code_information": [{"code": "941", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13589.28, "maximum": 22165.67, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 22165.67, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13589.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS", "code_information": [{"code": "876", "type": "MS-DRG"}], "standard_charges": [{"minimum": 274.0, "maximum": 24232.28, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1736.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1875.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2672.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 304.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 274.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1885.0, "methodology": "per diem"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 24232.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OATS KIT (OSTEOCHONDRAL ALLOGRAFT TRANSFER SYSTEM) 16MM FLAT HEAD REAMER, DELIVERY TUBE, DRILL PINGU", "code_information": [{"code": "ABS-1981-16S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2393.28, "discounted_cash": 1435.97, "setting": "both", "billing_class": "facility"}]}, {"description": "OB PE BIOCHEM ASSAY PGF ALG", "code_information": [{"code": "243U", "type": "CPT"}], "standard_charges": [{"minimum": 160.32, "maximum": 188.62, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 188.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 160.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB PRTRM BRTH IBP4 SHBG MEAS", "code_information": [{"code": "247U", "type": "CPT"}], "standard_charges": [{"minimum": 1866.64, "maximum": 2196.19, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2196.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1866.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB US < 14 WKS ADDL FETUS", "code_information": [{"code": "76802", "type": "CPT"}], "standard_charges": [{"minimum": 174.61, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 174.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 350.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 350.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 369.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 332.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 247.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OB US >= 14 WKS ADDL FETUS", "code_information": [{"code": "76810", "type": "CPT"}], "standard_charges": [{"minimum": 259.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 259.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 520.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 520.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 547.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 492.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 366.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OB US DETAILED ADDL FETUS", "code_information": [{"code": "76812", "type": "CPT"}], "standard_charges": [{"minimum": 208.39, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 208.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 418.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 418.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 440.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 396.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 295.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OB US FOLLOW-UP PER FETUS", "code_information": [{"code": "76816", "type": "CPT"}], "standard_charges": [{"minimum": 78.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 78.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 156.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 156.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 164.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 148.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 110.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB US NUCHAL MEAS 1 GEST", "code_information": [{"code": "76813", "type": "CPT"}], "standard_charges": [{"minimum": 351.6, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 351.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 706.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 706.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 743.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 669.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 498.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": 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"plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 176.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 354.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCULT BLD FECES 1-3 TESTS", "code_information": [{"code": "82272", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 52.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 46.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 34.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OCTAGON DRIVER 03.611.092", "code_information": [{"code": "3.611.092", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 284.4, "setting": "both", "billing_class": "facility"}]}, {"description": "OCULAR BLOOD FLOW MEASURE", "code_information": [{"code": "198T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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[{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR INSTRUMNT SCREEN BIL", "code_information": [{"code": "99177", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR LUBRICANT OINTMENT (ARTIFICIAL TEARS) 3.5 GM", "code_information": [{"code": "MED0010", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 30.5, "discounted_cash": 18.3, "setting": "both", 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"standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR RECONST TRANSPLANT", "code_information": [{"code": "65781", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR SECURE FLEX HF SURGICAL GONIO OSIG", "code_information": [{"code": "OSIG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 124.8, "discounted_cash": 74.88, "setting": "both", "billing_class": "facility"}]}, {"description": "OCULAR SURFACE RECON. 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": 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"maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 527.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1059.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1059.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1115.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1003.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 747.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 188.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 160.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONDANSETRON 4 MG", "code_information": [{"code": "S0119", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONDANSETRON ORAL", "code_information": [{"code": "Q0162", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OOCYTE IDENTIFICATION", "code_information": [{"code": "89254", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 331.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 665.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 460.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 391.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OOPHORECTOMY 58940", "code_information": [{"code": "58940", "type": "CPT"}, {"code": "1481370", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OOPHORECTOMY WITH BIOPSY 58943", "code_information": [{"code": "58943", "type": "CPT"}, {"code": "1481371", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN AORTIC TUBE PROSTH REPR", "code_information": [{"code": "34830", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN CHEST HEART MASSAGE", "code_information": [{"code": "32160", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN HRV UXTR ART 1 SGM CAB", "code_information": [{"code": "35600", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN IMPLANT HYPOGLOSSAL NERVE NEUROSTIM 64582", "code_information": [{"code": "64582", "type": "CPT"}, {"code": "46008051", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 37880.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 37880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34092.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN IMPLANTATION  CRANIAL NERVE 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 36437.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 63075.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56768.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN IMPLANTATION OF NEUROSTIMULATOR ELECTRODE/NEUROMUSCULAR 64580", "code_information": [{"code": "64580", "type": "CPT"}, {"code": "1481075", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": 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"plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF ACUTE SHOULDER DISLOCATION 23660", "code_information": [{"code": "23660", "type": "CPT"}, {"code": "21894239", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1150.6, 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TX DPRSD FRONT SINUS FX", "code_information": [{"code": "21343", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TX ILIAC SPINE UNI/BIL", "code_information": [{"code": "G0412", "type": "HCPCS"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TX POST PELVIC FXCTURE", "code_information": [{"code": "G0415", "type": "HCPCS"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN WEDGE/BX LUNG INFILTR", "code_information": [{"code": "32096", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN WEDGE/BX LUNG NODULE", "code_information": [{"code": "32097", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT 1ST", "code_information": [{"code": "37236", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT EA ADD", "code_information": [{"code": "37237", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT EA ADD", "code_information": [{"code": "37239", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT SAME", "code_information": [{"code": "37238", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPENER 2942011 DL RETRACTOR OPENER 2942011", "code_information": [{"code": "2942011", "type": "CDM"}], "standard_charges": [{"gross_charge": 1187.03, "discounted_cash": 712.22, "setting": "both", "billing_class": "facility"}]}, {"description": "OPH AMD ALYS 3 GENE VARIANTS", "code_information": [{"code": "205U", "type": "CPT"}], "standard_charges": [{"minimum": 116.98, "maximum": 137.63, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 137.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 116.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX ANT SGM US UNI/BI", "code_information": [{"code": "76513", "type": "CPT"}], "standard_charges": [{"minimum": 129.55, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 129.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 260.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 260.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 273.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 246.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 183.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX B-SCAN", "code_information": [{"code": "76512", "type": "CPT"}], "standard_charges": [{"minimum": 91.22, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 91.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 183.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 183.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 192.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 173.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 129.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX B-SCAN&QUAN A-SCAN", "code_information": [{"code": "76510", "type": "CPT"}], "standard_charges": [{"minimum": 177.85, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 177.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 357.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 357.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 375.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 338.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 251.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 508.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 431.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX QUAN A-SCAN ONLY", "code_information": [{"code": "76511", "type": "CPT"}], "standard_charges": [{"minimum": 111.91, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 111.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 224.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 224.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 236.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 212.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 158.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPHTHALMIC BIOMETRY", "code_information": [{"code": "92136", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPHTHALMODYNAMOMETRY", "code_information": [{"code": "92260", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIATES 1 OR MORE", "code_information": [{"code": "80361", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 29.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 29.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 30.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 27.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 20.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIOID &OPIATE ANALOG 5/MORE", "code_information": [{"code": "80364", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 21.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 42.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 42.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 45.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 40.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 30.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIOIDS & OPIATE ANALOGS 1/2", "code_information": [{"code": "80362", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 35.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 35.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 36.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 33.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 24.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIOIDS & OPIATE ANALOGS 3/4", "code_information": [{"code": "80363", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN AX/SUBCLA ART EXPOS", "code_information": [{"code": "34715", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN AX/SUBCLA ART EXPOS CNDT", "code_information": [{"code": "34716", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN BRACH ART EXPOS", "code_information": [{"code": "34834", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3330.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4892.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6688.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6336.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4717.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN FEM ART EXPOS", "code_information": [{"code": "34812", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN FEM ART EXPOS CNDT CRTJ", "code_information": [{"code": "34714", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN ILAC ART EXPOS CNDT CRTJ", "code_information": [{"code": "34833", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3330.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4892.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6688.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6336.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4717.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN ILIAC ART EXPOS", "code_information": [{"code": "34820", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX W/BONE GRFT", "code_information": [{"code": "21408", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTIC NERVE DECOMPRESSION 67570", "code_information": [{"code": "67570", "type": "CPT"}, {"code": "1481449", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTICAL ENDOMICROSCPY INTERP", "code_information": [{"code": "88375", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 138.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 118.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTICAL FIBER SINGLE USE PERFORMANCE SURGICAL OPTICAL FIBER 365 ?M", "code_information": [{"code": "OAF703611", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "OPTIEDGE ACRY 13.5MM 6 OPT MOD C PMMA  AR40M -6.0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "AR40M -6.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 325.0, "discounted_cash": 195.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OPTO-ACOUSTIC IMG BREAST UNI", "code_information": [{"code": "857T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPTOKINETIC NYSTAGMUS TEST", "code_information": [{"code": "92534", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTOKINETIC NYSTAGMUS TEST", "code_information": [{"code": "92544", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX OF RIB FX W/FIXJ SCOPE", "code_information": [{"code": "21811", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX POST ANKLE FX", "code_information": [{"code": "27769", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX SHO DISLC NECK FX FIXJ", "code_information": [{"code": "23680", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX STRCLV DSLC AQ/CHRN GRF", "code_information": [{"code": "23532", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": [{"code": "61585", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee 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"standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOTOMY WITH BONE FLAP OR WINDOW FOR EXPLORATION WITH OR WITHOUT BIOPSY 67450", "code_information": [{"code": "67450", "type": "CPT"}, {"code": "1481452", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOTOMY WITH BONE FLAP OR WINDOW LATERAL APPROACH;WITH REMOVAL OF LESION 67420", "code_information": [{"code": "67420", "type": "CPT"}, {"code": "1481453", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOTOMY WITH BONE FLAP OR WINDOW WITH DRAINAGE 67440", "code_information": [{"code": "67440", "type": "CPT"}, {"code": "1481454", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOTOMY WITH BONE FLAP OR WINDOW WITH REMOVAL OF BONE FOR DECOMPRESSION 67445", "code_information": [{"code": "67445", "type": "CPT"}, {"code": "1481455", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 14275.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", 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"plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOSELECT PLUS DBM PUTTY 10.0CC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "309500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2660.0, "discounted_cash": 1596.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOSELECT PLUS DBM PUTTY 2.5CC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "309425", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1590.0, "discounted_cash": 954.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOSET  RESORBABLE BEAD KIT FAST CURE 25CC 84000311", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "84000311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3900.0, "discounted_cash": 2340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOSET  RESORBABLE BEAD KIT STANDARD CURE 25CC 84000211", "code_information": [{"code": "84000211", "type": "CDM"}], "standard_charges": [{"gross_charge": 3900.0, "discounted_cash": 2340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOSET  RESORBABLE MINI BEAD KIT FAST CURE 84000611", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "84000611", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1866.0, "discounted_cash": 1119.6, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOSET  RESORBABLE MINI BEAD KIT STANDARD CURE 5CC 84000511", "code_information": [{"code": "84000511", "type": "CDM"}], "standard_charges": [{"gross_charge": 2380.0, "discounted_cash": 1428.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOSPONGE", "code_information": [{"code": "109550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3271.61, "discounted_cash": 1962.97, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOSPONGE 12MM BLOCK", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "109612     ACCEL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2609.5, "discounted_cash": 1565.7, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOSPONGE FILLER 5.0CC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "109250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOSPONGE FILLER FINE 10.0CC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "109310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2128.0, "discounted_cash": 1276.8, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOSTRAND PLUS X-SMALL 56730010", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "56730010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1430.61, "discounted_cash": 858.37, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1VRT SGM EA", 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"standard_charges": [{"gross_charge": 273.34, "discounted_cash": 164.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOME BLADE 17.5 111755", "code_information": [{"code": "111755", "type": "CDM"}], "standard_charges": [{"gross_charge": 273.34, "discounted_cash": 164.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOME BLADE 20MM 111756", "code_information": [{"code": "111756", "type": "CDM"}], "standard_charges": [{"gross_charge": 273.34, "discounted_cash": 164.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOME FLEXIBLE SS 12 X 93MM", "code_information": [{"code": "6210-0-740", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 646.38, "discounted_cash": 387.83, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOME FLEXIBLE SS 8 X 80MM", "code_information": [{"code": "6210-0-730", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 646.38, "discounted_cash": 387.83, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOME STRAIGHT/12MM WIDTH 389.72", "code_information": [{"code": "389.72", "type": "CDM"}], "standard_charges": [{"gross_charge": 2023.92, "discounted_cash": 1214.35, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOME STRAIGHT/18MM WIDTH 389.73", "code_information": [{"code": "389.73", "type": "CDM"}], "standard_charges": [{"gross_charge": 2023.92, "discounted_cash": 1214.35, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOME STRAIGHT/25MM WIDTH 389.74", "code_information": [{"code": "389.74", "type": "CDM"}], "standard_charges": [{"gross_charge": 2023.92, "discounted_cash": 1214.35, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOME-STRAIGHT 03.605.508", "code_information": [{"code": "3.605.508", "type": "CDM"}], "standard_charges": [{"gross_charge": 2023.92, "discounted_cash": 1214.35, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOME-STRAIGHT 10MM 250MM LENGTH/230MM HANDLE 389.575", "code_information": [{"code": "389.575", "type": "CDM"}], "standard_charges": [{"gross_charge": 2023.92, "discounted_cash": 1214.35, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOME-STRAIGHT 5MM 250MM LENGTH/230MM HANDLE 389.574", "code_information": [{"code": "389.574", "type": "CDM"}], "standard_charges": [{"gross_charge": 2023.92, "discounted_cash": 1214.35, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOMY 2ND-5TH METATARSAL W/AUTOGRAFT-EACH 28308", "code_information": [{"code": "28308", "type": "CPT"}, {"code": "1481484", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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DIAGNOSES WITH O.R. 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"standard_charge_dollar": 34236.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 56634.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 73234.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 64025.88, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 48899.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 46454.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 44009.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", 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PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "358", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9896.52, "maximum": 15369.54, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 15369.54, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9896.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH CC", "code_information": [{"code": "92", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6923.82, "maximum": 12007.78, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 12007.78, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6923.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC", "code_information": [{"code": "91", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11832.08, "maximum": 20675.33, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 20675.33, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11832.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "93", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5415.45, "maximum": 8952.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 8952.24, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5415.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT", "code_information": [{"code": "124", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9771.74, "maximum": 14788.83, "estimated_discounted_cash": 13294.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 14788.83, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9771.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF THE EYE WITHOUT MCC", "code_information": [{"code": "125", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5946.87, "maximum": 9365.09, "estimated_discounted_cash": 13570.72, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9365.09, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5946.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC", "code_information": [{"code": "155", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6483.42, "maximum": 10588.89, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10588.89, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6483.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC", "code_information": [{"code": "154", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10617.31, "maximum": 18445.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 18445.49, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10617.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "156", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4843.67, "maximum": 7626.36, "estimated_discounted_cash": 19923.59, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7626.36, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4843.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. 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PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "145", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13438.0, "maximum": 13438.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13438.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC", "code_information": [{"code": "629", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17166.06, "maximum": 25509.29, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 25509.29, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 17166.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC", "code_information": [{"code": "628", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26974.5, "maximum": 44752.13, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 44752.13, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 26974.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "630", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11263.23, "maximum": 15893.54, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 15893.54, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11263.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC", "code_information": [{"code": "319", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24102.0, "maximum": 73234.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 61334.0, "methodology": "case rate"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 49823.14, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 24102.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 38367.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 32612.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 73234.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 48899.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 46454.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 44009.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 41564.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC", "code_information": [{"code": "320", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17314.0, "maximum": 73234.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 26254.46, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 17314.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 27562.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 23428.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 73234.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 48899.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 46454.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 44009.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 41564.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER FACTORS INFLUENCING HEALTH STATUS", "code_information": [{"code": "951", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5860.26, "maximum": 6430.91, "estimated_discounted_cash": 1570.9, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6430.91, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5860.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER FEMALE REPRODUCTIVE SYSTEM O.R. 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PROCEDURES WITH CC", "code_information": [{"code": "424", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16082.67, "maximum": 25897.19, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 25897.19, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16082.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC", "code_information": [{"code": "423", "type": "MS-DRG"}], "standard_charges": [{"minimum": 28963.64, "maximum": 46132.45, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 46132.45, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 28963.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "425", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10957.89, "maximum": 17532.46, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 17532.46, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10957.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER IMMUNOELECTROPHORESIS", "code_information": [{"code": "86325", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 92.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 185.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 185.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 195.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 175.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 130.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 67.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 57.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC", "code_information": [{"code": "868", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7904.45, "maximum": 11910.23, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11910.23, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7904.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC", "code_information": [{"code": "867", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15655.49, "maximum": 24320.65, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 24320.65, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 15655.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "869", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5636.39, "maximum": 8161.7, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 8161.7, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5636.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC", "code_information": [{"code": "922", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11438.66, "maximum": 19161.17, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 19161.17, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11438.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC", "code_information": [{"code": "923", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6384.33, "maximum": 11567.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11567.71, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6384.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC", "code_information": [{"code": "699", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7544.79, "maximum": 11567.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11567.71, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7544.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC", "code_information": [{"code": "698", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11854.83, "maximum": 19064.77, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 19064.77, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11854.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "700", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5576.2, "maximum": 7873.62, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7873.62, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5576.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC", "code_information": [{"code": "674", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16970.81, "maximum": 26181.87, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 26181.87, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16970.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC", "code_information": [{"code": "673", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26257.38, "maximum": 47518.44, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 47518.44, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 26257.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "675", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11929.7, "maximum": 17753.63, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 17753.63, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11929.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC", "code_information": [{"code": "271", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34015.64, "maximum": 66628.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 39066.38, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 41856.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 66628.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 34236.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 56634.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 34015.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC", "code_information": [{"code": "270", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34236.0, "maximum": 66628.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 58218.49, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 41856.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 66628.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 34236.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 56634.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 49280.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "272", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25489.82, "maximum": 66628.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 28379.95, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 41856.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 66628.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 34236.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 56634.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 25489.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC", "code_information": [{"code": "729", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7941.88, "maximum": 12486.41, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 12486.41, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7941.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "730", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4172.06, "maximum": 6883.46, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6883.46, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 4172.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC", "code_information": [{"code": "717", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14344.56, "maximum": 21045.08, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 21045.08, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14344.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "718", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9047.28, "maximum": 13972.21, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13972.21, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9047.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC", "code_information": [{"code": "715", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16220.67, "maximum": 25613.64, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 25613.64, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16220.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "716", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10738.42, "maximum": 16097.7, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 16097.7, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10738.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MENTAL DISORDER DIAGNOSES", "code_information": [{"code": "887", "type": "MS-DRG"}], "standard_charges": [{"minimum": 274.0, "maximum": 7813.43, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1736.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1875.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2672.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 304.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 274.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1885.0, "methodology": "per diem"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7813.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC", "code_information": [{"code": "964", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10825.77, "maximum": 17014.13, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 17014.13, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10825.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC", "code_information": [{"code": "963", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20515.3, "maximum": 30812.81, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 30812.81, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 20515.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC", "code_information": [{"code": "965", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7151.36, "maximum": 10350.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10350.71, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7151.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC", "code_information": [{"code": "565", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4699.0, "maximum": 11565.44, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11565.44, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7162.37, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 4699.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC", "code_information": [{"code": "564", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4699.0, "maximum": 17797.87, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 17797.87, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11539.95, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 4699.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "566", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4699.0, "maximum": 8484.95, "estimated_discounted_cash": 28183.89, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 8484.95, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5595.28, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 4699.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. 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Therapeutic Services (Extension Of 094x) Kinesiotherapy", "code_information": [{"code": "952", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 67.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Outpatient Services General", "code_information": [{"code": "500", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data 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combination", "standard_charge_percentage": 67.5, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ova and Parasites Exam", "code_information": [{"code": "87177", "type": "CPT"}, {"code": "633911", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "gross_charge": 68.0, "discounted_cash": 40.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 59.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 119.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 119.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 125.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 113.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 84.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 26.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 22.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "P-SER 12/14 PF PLASMA COLLARED SZ 4 118-00-04", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "118-00-04", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10140.0, "discounted_cash": 6084.0, "setting": "both", "billing_class": "facility"}]}, {"description": "P32 CHROMIC PHOSPHATE", "code_information": [{"code": "A9564", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "P32 NA PHOSPHATE", "code_information": [{"code": "A9563", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PABPN1 GENE DETC ABNOR ALLEL", "code_information": [{"code": "81312", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 401.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 340.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PACK ACC VITREORETINAL W/ TITANIUM FRAGMENTATION NDL AND NDL WRENCH AND VACUUMM", "code_information": [{"code": "1021HP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.18, "discounted_cash": 108.11, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ACL DISP", "code_information": [{"code": "234-020-280", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 882.38, "discounted_cash": 529.43, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ACL SOFT TISSUE", "code_information": [{"code": "234-020-290", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1077.01, "discounted_cash": 646.21, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK AFFIRM DELIVERY 658.959S", "code_information": [{"code": "658.959S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 747.46, "discounted_cash": 448.48, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK APPLICATOR EXTENDED TIP DURASEAL 8CM SINGLE PACK 201108", "code_information": [{"code": "201108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 891.1, "discounted_cash": 534.66, "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": 560.2, "discounted_cash": 336.12, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROSCOPY CUSTOM", "code_information": [{"code": "DYNJ26892", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.35, "discounted_cash": 101.61, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROSCOPY ICSH", "code_information": [{"code": "DYNJ26892I", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 173.88, "discounted_cash": 104.33, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROSOCPY KNEE STANDARD TRAY IV LF STRL", "code_information": [{"code": "DYNJS0811", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 181.25, "discounted_cash": 108.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ASSY SHIP CENA 9U 45 BAL 8065000134", "code_information": [{"code": "8065000134", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 301.34, "discounted_cash": 180.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CATARACT CUSTOM PICK DR. KURIACHAN", "code_information": [{"code": "PPK6752", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.39, "discounted_cash": 105.83, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CATARACT PRE OP DISPOSABLE/SNGLE USE DYKS1252", "code_information": [{"code": "DYKS1252", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.97, "discounted_cash": 26.98, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CONVENIENCE TIGHTROPE MEDIAL PATELLOFEMORAL LIGAMENT ANTERIOR CRUCIATE LIGAMENT BIOCOMPOSITE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1360CST-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6266.0, "discounted_cash": 3759.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM  HEAD & NECK PE41HNLAE", "code_information": [{"code": "PE41HNLAE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.44, "discounted_cash": 120.26, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BASIC EYE", "code_information": [{"code": "AS6667", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.93, "discounted_cash": 102.56, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC 360 PN41SPLA2", "code_information": [{"code": "PN41SPLA2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 541.31, "discounted_cash": 324.79, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC 360 PN41SPLA3", "code_information": [{"code": "PN41SPLA3", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 541.31, "discounted_cash": 324.79, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC 360 PN41SPLAA", "code_information": [{"code": "PN41SPLAA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 592.57, "discounted_cash": 355.54, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC 360 PN41SPLAB", "code_information": [{"code": "PN41SPLAB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 543.65, "discounted_cash": 326.19, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC ACDF PN41ACLA4", "code_information": [{"code": "PN41ACLA4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 439.49, "discounted_cash": 263.69, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC ACDF PN41ACLA5", "code_information": [{"code": "PN41ACLA5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 439.49, "discounted_cash": 263.69, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC ACDF PN41ACLAA", "code_information": [{"code": "PN41ACLAA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 466.04, "discounted_cash": 279.62, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC ACDF PN41ACLAG", "code_information": [{"code": "PN41ACLAG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 439.49, "discounted_cash": 263.69, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC D&C SMA41DCLA7", "code_information": [{"code": "SMA41DCLA7", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 193.74, "discounted_cash": 116.24, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC D&C SMA41DCLA9", "code_information": [{"code": "SMA41DCLA9", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 193.74, "discounted_cash": 116.24, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC D&C SMA41DCLAA", "code_information": [{"code": "SMA41DCLAA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 132.0, "discounted_cash": 79.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC GYN LAPAROSCOPY PB41GLLAA", "code_information": [{"code": "PB41GLLAA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 428.69, "discounted_cash": 257.21, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC HEAD & NECK PE41HNLA6", "code_information": [{"code": "PE41HNLA6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 194.56, "discounted_cash": 116.74, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC HEAD & NECK PE41HNLA7", "code_information": [{"code": "PE41HNLA7", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 194.56, "discounted_cash": 116.74, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC HEAD & NECK PE41HNLAA", "code_information": [{"code": "PE41HNLAA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 218.45, "discounted_cash": 131.07, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC HEAD & NECK PE41HNLAD", "code_information": [{"code": "PE41HNLAD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 195.95, "discounted_cash": 117.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC KNEE ARTHROSCOPY SOP41KALAA", "code_information": [{"code": "SOP41KALAA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 264.81, "discounted_cash": 158.89, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC KNEE ARTHROSCOPY SOP41KALAC", "code_information": [{"code": "SOP41KALAC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 241.99, "discounted_cash": 145.19, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC LAMI PN41LML10", "code_information": [{"code": "PN41LML10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 458.07, "discounted_cash": 274.84, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC LAMI PN41LMLA8", "code_information": [{"code": "PN41LMLA8", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 416.5, "discounted_cash": 249.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC LAMI PN41LMLAA", "code_information": [{"code": "PN41LMLAA", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 410.86, "discounted_cash": 246.52, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC LAMI PN41LMLAH", "code_information": [{"code": "PN41LMLAH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 458.07, "discounted_cash": 274.84, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC MINOR LAP SBA41LTLA7", "code_information": [{"code": "SBA41LTLA7", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 212.1, "discounted_cash": 127.26, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC MINOR LAP SBA41LTLA8", "code_information": [{"code": "SBA41LTLA8", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 212.1, "discounted_cash": 127.26, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC MINOR LAP SBA41LTLAC", "code_information": [{"code": "SBA41LTLAC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 204.01, "discounted_cash": 122.41, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC ORTHO MINOR PO41MNLA7", "code_information": [{"code": "PO41MNLA7", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 283.39, "discounted_cash": 170.03, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC ORTHO MINOR PO41MNLAA", "code_information": [{"code": "PO41MNLAA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 307.37, "discounted_cash": 184.42, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC ORTHO MINOR PO41MNLAD", "code_information": [{"code": "PO41MNLAD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 283.86, "discounted_cash": 170.32, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC PROSTATE PU41PRLA3", "code_information": [{"code": "PU41PRLA3", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1204.71, "discounted_cash": 722.83, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC PROSTATE PU41PRLA4", "code_information": [{"code": "PU41PRLA4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1194.37, "discounted_cash": 716.62, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC PROSTATE PU41PRLA5", "code_information": [{"code": "PU41PRLA5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1179.1, "discounted_cash": 707.46, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC PROSTATE PU41PRLA6", "code_information": [{"code": "PU41PRLA6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1201.84, "discounted_cash": 721.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC PROSTATE PU41PRLAA", "code_information": [{"code": "PU41PRLAA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1312.76, "discounted_cash": 787.66, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC PSU DYKM2230", "code_information": [{"code": "DYKM2230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.11, "discounted_cash": 67.27, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC SHOULDER ARTHROSCOPY PO41ASLAA", "code_information": [{"code": "PO41ASLAA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 413.23, "discounted_cash": 247.94, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC SHOULDER ARTHROSCOPY PO41ASLAD", "code_information": [{"code": "PO41ASLAD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 470.46, "discounted_cash": 282.28, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC SHOULDER ARTHROSCOPY PO41ASLAE", "code_information": [{"code": "PO41ASLAE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 473.72, "discounted_cash": 284.23, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC TOTAL JOINT PO41TJLA9", "code_information": [{"code": "PO41TJLA9", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 542.69, "discounted_cash": 325.61, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC TOTAL JOINT PO41TJLAH", "code_information": [{"code": "PO41TJLAH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 546.1, "discounted_cash": 327.66, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BSWSHLC TOTAL PO41TJLAA", "code_information": [{"code": "PO41TJLAA", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 607.44, "discounted_cash": 364.46, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM CERVICAL DISC ICSH LF", "code_information": [{"code": "DYNJ17244", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 318.68, "discounted_cash": 191.21, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM D&C GYN BSHLC", "code_information": [{"code": "DYNJ901283", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 251.66, "discounted_cash": 151.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM D&C SMA41DCLAH", "code_information": [{"code": "SMA41DCLAH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 195.13, "discounted_cash": 117.08, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM DR RAMSEY ICSH", "code_information": [{"code": "PPK7064", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.11, "discounted_cash": 105.67, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM GYN D&C BSHLC", "code_information": [{"code": "DYNJ49334", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 217.53, "discounted_cash": 130.52, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM HEAD & NECK PE41HNLA8", "code_information": [{"code": "PE41HNLA8", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 197.47, "discounted_cash": 118.48, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM HEAD AND NECK BSHLC", "code_information": [{"code": "DYNJ901286", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 306.74, "discounted_cash": 184.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM HEAD AND NECK ICSH", "code_information": [{"code": "DYNJ26888", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 121.06, "discounted_cash": 72.64, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM KNEE ARTHRO BSHLC", "code_information": [{"code": "DYNJ26892K", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 265.72, "discounted_cash": 159.43, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM KNEE ARTHROSCOPY BSHLC", "code_information": [{"code": "DYNJ901284", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.57, "discounted_cash": 189.94, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM KNEE SOP41KABMF", "code_information": [{"code": "SOP41KABMF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 226.03, "discounted_cash": 135.62, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM LAMI PN41LMLAI", "code_information": [{"code": "PN41LMLAI", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.85, "discounted_cash": 276.51, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM LAMINECTOMY ICSH LF", "code_information": [{"code": "DYNJ31004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 262.34, "discounted_cash": 157.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM LAP CHOLE", "code_information": [{"code": "LCB52S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 658.13, "discounted_cash": 394.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM MINOR LAP ICSH", "code_information": [{"code": "DYNJ26889F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 186.99, "discounted_cash": 112.19, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM MINOR LAP SBA41LTLAD", "code_information": [{"code": "SBA41LTLAD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 205.4, "discounted_cash": 123.24, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM MINOR LAPAROTOMY BSHLC", "code_information": [{"code": "DYNJ901288", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 244.74, "discounted_cash": 146.84, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM MINOR LAPAROTOMY CARDINAL BSHLC", "code_information": [{"code": "SBA41LTLAA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 221.96, "discounted_cash": 133.18, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM ORTHO MINOR BSHLC", "code_information": [{"code": "DYNJ901289", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 338.37, "discounted_cash": 203.02, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM ORTHO MINOR PO41MNLAE", "code_information": [{"code": "PO41MNLAE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 278.46, "discounted_cash": 167.08, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM PICK DR BHATIA", "code_information": [{"code": "PPK4558", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 470.14, "discounted_cash": 282.08, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM PICK DR GICHERU", "code_information": [{"code": "PPK4093", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 331.75, "discounted_cash": 199.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM PICK DR GREGORY", "code_information": [{"code": "PPK4094", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 331.75, "discounted_cash": 199.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM PICK DR KLEIN", "code_information": [{"code": "PPK4108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 173.74, "discounted_cash": 104.24, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM PICK DR LE PPK3367", "code_information": [{"code": "PPK3367", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.98, "discounted_cash": 122.39, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM PICK DR REINKE", "code_information": [{"code": "PPK4106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 182.25, "discounted_cash": 109.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM PICK DR WHITAKER", "code_information": [{"code": "PPK4107", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 286.55, "discounted_cash": 171.93, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM PROSTATE PU41PRL12", "code_information": [{"code": "PU41PRL12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.06, "discounted_cash": 720.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM PROSTATE PU41PRL13", "code_information": [{"code": "PU41PRL13", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1201.84, "discounted_cash": 721.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM PROSTATE PU41PRLA8", "code_information": [{"code": "PU41PRLA8", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1201.84, "discounted_cash": 721.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM SHOULDER ARTHROSCOPY BSHLC", "code_information": [{"code": "DYNJ901290A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 445.94, "discounted_cash": 267.56, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM SHOULDER ARTHROSCOPY ICSH", "code_information": [{"code": "DYNJ901290", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 403.04, "discounted_cash": 241.82, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM TOTAL JOINT BSHLC", "code_information": [{"code": "DYNJ901291", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 663.44, "discounted_cash": 398.06, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM TOTAL JOINT PO41TJL10", "code_information": [{"code": "PO41TJL10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 553.09, "discounted_cash": 331.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM TOTAL JOINT PO41TJLAJ", "code_information": [{"code": "PO41TJLAJ", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 557.3, "discounted_cash": 334.38, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CYSTOSCOPY SPP99CY1AA", "code_information": [{"code": "SPP99CY1AA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.82, "discounted_cash": 52.69, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CYSTOTOMY NUMBER II", "code_information": [{"code": "DYNJS0502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.41, "discounted_cash": 81.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK DRP FILL SZ W/ C ARM STERIQUICK DRP GRAY FOOTSWITCH COVER IMAGEINTENSIFIER", "code_information": [{"code": "10108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.23, "discounted_cash": 37.94, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ENDOBUTTON CL ULTRA PAC 1.2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72202799", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 995.28, "discounted_cash": 597.17, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FILM 3IN X 5IN BIORESORBABLE HYCLORONIC ACID SUPRAFILM", "code_information": [{"code": "5086-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 442.4, "discounted_cash": 265.44, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM 1.2CC BA2X COMPRESSION RESISTANT VITOSS STRL IMP", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2102-2101S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2220.02, "discounted_cash": 1332.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM 10CC BONE IMPLANT COMPRESSION RESISTANT BA2X VITOSS", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2102-2110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12126.4, "discounted_cash": 7275.84, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM 2.5CC VISTOSS BA", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2102-1602", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM 2.5CC VITOSS BA2X", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2102-2102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3294.98, "discounted_cash": 1976.99, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM 5CC VITOSS", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2102-2105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6497.4, "discounted_cash": 3898.44, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM VITOSS BBTRAUMA 2.5CC", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2102-2202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4313.4, "discounted_cash": 2588.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FRAGMENTATION 20GA LIGHTWEIGHT IMPROVED ERGONOMIC DESIGN CONSTELLATION", "code_information": [{"code": "8065750958", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 227.01, "discounted_cash": 136.21, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK GEL HOT COLD REUSABLE 10X12", "code_information": [{"code": "MDS138025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.32, "discounted_cash": 8.59, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK GENERAL PRE OP DYKS1253", "code_information": [{"code": "DYKS1253", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.89, "discounted_cash": 31.73, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ICE 4.5IN X 10.SIN SM GENERAL PURPINSTANT W/ CLIP CLOSURE AND TIES SOFT N C", "code_information": [{"code": "33625", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.8, "discounted_cash": 2.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK IMPLANT FUSION HAT-TRICK 2.7MM MID 4.0 MMINTER PHALANGEAL  PROXIMAL PHALANX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72204366", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3380.0, "discounted_cash": 2028.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK IMPLANT PIP FUSION HAT-TRICK PROXIMAL PHALANX 4.2MM MIDDLE PHALANX 4.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72204369", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2626.4, "discounted_cash": 1575.84, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK LAMINECTOMY TRAY I ONE BEDSIDE PAPER BAG ONE BLADE NUMBER 10 ONE BLADE NUMB", "code_information": [{"code": "DYNJS1002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 204.36, "discounted_cash": 122.62, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK LAPAROSCOPY STANDARD CUSTOM TRAY II LF STRL", "code_information": [{"code": "DYNJS0910A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 125.4, "discounted_cash": 75.24, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK LAPIPLASTY LESSER TMT FIXATION SK28", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK28", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5330.0, "discounted_cash": 3198.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK LITHOTOMY ABDOMINAL 29146", "code_information": [{"code": "29146", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.22, "discounted_cash": 34.33, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK MIS STERILE BUMP", "code_information": [{"code": "57S1MI08", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2008.8, "discounted_cash": 1205.28, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK NOVASURE CO2 CARTRIDGE", "code_information": [{"code": "815012US", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.6, "discounted_cash": 36.96, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK OPHTH CONSTELLATION TOTAL PLUS VITRECTOMY 23GA", "code_information": [{"code": "8065751613", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1177.2, "discounted_cash": 706.32, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK OPHTHALMIC W/ BALANCE SALT SOL BSS PLUS", "code_information": [{"code": "AS6666", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1132.03, "discounted_cash": 679.22, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ORTHO MINOR", "code_information": [{"code": "DYNJ26890G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 177.32, "discounted_cash": 106.39, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PHACO 23GA .9MM ACCURUS COMBINED", "code_information": [{"code": "8065750814", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1147.07, "discounted_cash": 688.24, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PHACO CUSTOM W/ BALANCE SALT SOL PLAIN AND DUOVISC", "code_information": [{"code": "AS6537", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 532.9, "discounted_cash": 319.74, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PIN 1/8IN X 3IN STEINMANN PFC TRIANGULAR END W/ FOUR PIN AND 2 DRILL STRL", "code_information": [{"code": "86-4192", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 512.05, "discounted_cash": 307.23, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PIN VERSITOMIC", "code_information": [{"code": "234-108-200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 750.52, "discounted_cash": 450.31, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROC DILATATION AND CURETTAGE GYNECOLOGY SURG TRAY LF STRL", "code_information": [{"code": "DYNJS0901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 92.99, "discounted_cash": 55.79, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROC NASAL EAR NOSE THROAT ENT TRAY I ONE BEDISDE PAPER BAG ONE GRADUATED B", "code_information": [{"code": "DYNJS0702", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 139.59, "discounted_cash": 83.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROCEDURE BASIC CYSTOSCOPY TRAY I LF STRL", "code_information": [{"code": "DYNJS0501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.6, "discounted_cash": 62.76, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROCEDURE HAT-TRICK BIL", "code_information": [{"code": "72204326", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3640.0, "discounted_cash": 2184.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROCEDURE MAJOR EXTREMITY SURG TRAY IV LF STRL", "code_information": [{"code": "DYNJS0804", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.47, "discounted_cash": 90.28, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROCEDURE NUMBER 2 SURG OPHTHALMIC CUSTOM PAK", "code_information": [{"code": "AS14309-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 184.23, "discounted_cash": 110.54, "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": 1175.72, "discounted_cash": 705.43, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK RETINA PRE OP DISPOSABLE/SNGLE USE DYKS1254", "code_information": [{"code": "DYKS1254", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.01, "discounted_cash": 31.21, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SHOULDER CUSTOM ICSH", "code_information": [{"code": "DYNJ26891", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 305.01, "discounted_cash": 183.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SHOULDER DISPOSABLE PIN  14.00001", "code_information": [{"code": "14.00001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 208.0, "discounted_cash": 124.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SPINE MEDLINE", "code_information": [{"code": "DYNJS3069", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 425.53, "discounted_cash": 255.32, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK STERILE SURGICAL SETUP 114 DRESSING", "code_information": [{"code": "114 DRESSING", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.1, "discounted_cash": 6.06, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURG EYE BASIC CUSTOM", "code_information": [{"code": "A6667", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 159.34, "discounted_cash": 95.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURG UNIVERSAL I WITHOUT GOWN W/ REINFORCED TABLE COVER MAYO STAND COVER 2", "code_information": [{"code": "DYNJP1050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.98, "discounted_cash": 36.59, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL ANTERIOR CERVICAL CARDINAL CUSTOM BSHLC", "code_information": [{"code": "PN41ACLAB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 450.39, "discounted_cash": 270.23, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL ANTERIOR CERVICAL CARDINAL CUSTOM BSHLC VER C", "code_information": [{"code": "PN41ACLAC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 442.43, "discounted_cash": 265.46, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL CUSTOM HEAD AND NECK BSHLC", "code_information": [{"code": "DYNJ901286A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 278.62, "discounted_cash": 167.17, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL CUSTOM LAMINECTOMY BSHLC", "code_information": [{"code": "DYNJ901287A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 514.79, "discounted_cash": 308.87, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL CUSTOM TOTAL JOINT BSHLC", "code_information": [{"code": "DYNJ901291A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 618.08, "discounted_cash": 370.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL D AND C 070", "code_information": [{"code": "SPP99GY3AA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.85, "discounted_cash": 50.31, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL DR HUSAIN CUSTOM PIK", "code_information": [{"code": "PPK5586-04", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.25, "discounted_cash": 101.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL HEAD AND NECK CARDINAL CUSTOM BSHLC", "code_information": [{"code": "PE41HNLAB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.44, "discounted_cash": 120.26, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL LAP CHOLE II", "code_information": [{"code": "DYNJS3019", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.42, "discounted_cash": 21.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL LAPAROSCOPY 070", "code_information": [{"code": "SPP99LS2AA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.42, "discounted_cash": 60.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL LAPAROSCOPY 070 CARDINAL STANDARD", "code_information": [{"code": "spp99ls3aa", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 102.75, "discounted_cash": 61.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL MINOR LAPAROTOMY CARDINAL CUSTOM BSHLC", "code_information": [{"code": "SBA41LTLAB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 205.72, "discounted_cash": 123.43, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL MINOR LAPAROTOMY CUSTOM BSHLC", "code_information": [{"code": "DYNJ26889I", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 213.14, "discounted_cash": 127.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL TOTAL JOINT CARDINAL CUSTOM BSHLC", "code_information": [{"code": "PO41TJLAB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 571.63, "discounted_cash": 342.98, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL TOTAL JOINT CARDINAL CUSTOM BSHLC VER C", "code_information": [{"code": "PO41TJLAC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 570.54, "discounted_cash": 342.32, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SURGICAL TOTAL JOINT CARDINAL CUSTOM TCMC VER B", "code_information": [{"code": "SOP41TJBMB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 310.66, "discounted_cash": 186.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SUT CUSTOM PIKPAK DR HINES", "code_information": [{"code": "PPK5586", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 398.4, "discounted_cash": 239.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SYSTEM PROSTEP ORTHOPEDIC FIXATION INTERNAL MIS INSTRUMENT W/ BLADE STERILE DISPOSABLE 57S1MI07", "code_information": [{"code": "57S1MI07", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 816.62, "discounted_cash": 489.97, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK UC ARTHROSCOPE", "code_information": [{"code": "72203764", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ULTRASOUND 0.9MM TIP FLUID MANAGEMENT SYS ABSINFINITI STRL DISP", "code_information": [{"code": "8065741081", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.74, "discounted_cash": 106.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK UNIVERSAL 6 CS 29118", "code_information": [{"code": "29118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.73, "discounted_cash": 46.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK UNIVERSAL TENDONESIS", "code_information": [{"code": "1500-02-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1244.16, "discounted_cash": 746.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK UNIVERSAL VISCOUS FLUID CONTROL BL7600", "code_information": [{"code": "BL7600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 171.18, "discounted_cash": 102.71, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK VISUAL 20GA 23GA 25GA CANNULA VISUAL FUNCTION CORE HIGH SPEED EXTRACTION SL", "code_information": [{"code": "8065750957", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 204.36, "discounted_cash": 122.62, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK VITRECTOMY 20GA 5000 CPM STRAIGHT ENDOILLUMINATOR TOTAL PLUS CONSTELLATION", "code_information": [{"code": "8065751063", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1010.68, "discounted_cash": 606.41, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK VITRECTOMY 23GA 5000 CPM STRAIGHT ENDOILLUMINATOR TOTAL PLUS CONSTELLATION", "code_information": [{"code": "8065751058", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1121.04, "discounted_cash": 672.62, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK VITRECTOMY 23GA CONSTELLATION 10000 CPM TOTAL PLUS ULTRAVIT EDGEPLUS STERILE LATEX FREE DISPOSA", "code_information": [{"code": "8065752435", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1211.5, "discounted_cash": 726.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK VITRECTOMY 23GA STRAIGHT ENDOILLUMINATOR W/ EDGEPLUS NON VALVED ENTRY SYS F", "code_information": [{"code": "8065750828", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1097.33, "discounted_cash": 658.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK VITRECTOMY ANTINFINITI STRL", "code_information": [{"code": "8065750157", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 385.62, "discounted_cash": 231.37, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK VITRECTORY 23GA TOTAL PLUS  8065752436", "code_information": [{"code": "8065752436", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1246.92, "discounted_cash": 748.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK VITREORETINAL W/ ACCURUS 1500 PROBE USED W/ ACCURUS XS4 ONLY TOTAL PLUS STR", "code_information": [{"code": "8065750118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 167.36, "discounted_cash": 100.42, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK VITREORETINAL W/ ACCURUS 2500 PROBE TOTAL PLUS", "code_information": [{"code": "8065741017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 799.69, "discounted_cash": 479.81, "setting": "both", "billing_class": "facility"}]}, {"description": "PACKING BLOCK 606.003", "code_information": [{"code": "606.003", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.66, "discounted_cash": 719.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PACKING BLOCK FOR 26MM DEPTH/ 32MM WIDTH SYNFIXTM-LR 03.802.041", "code_information": [{"code": "3.802.041", "type": "CDM"}], "standard_charges": [{"gross_charge": 4782.24, "discounted_cash": 2869.34, "setting": "both", "billing_class": "facility"}]}, {"description": "PACKING BLOCK FOR 30MM DEPTH/ 38MM WIDTH SYNFIXTM-LR 03.802.042", "code_information": [{"code": "3.802.042", "type": "CDM"}], "standard_charges": [{"gross_charge": 4782.24, "discounted_cash": 2869.34, "setting": "both", "billing_class": "facility"}]}, {"description": "PACKING TUBE 11-1109-FD8-2", "code_information": [{"code": "11-1109-FD8-2", "type": "CDM"}], "standard_charges": [{"gross_charge": 610.47, "discounted_cash": 366.28, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD ABDOMINAL 5IN X 9IN LF STRL", "code_information": [{"code": "NON21450", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.55, "discounted_cash": 0.33, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD ABDOMINAL TENDERSORB 5X9 STERILE 9190A", "code_information": [{"code": "9190A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.77, "discounted_cash": 0.46, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD ADHSV ENT", "code_information": [{"code": "9732500XOM", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 22.71, "discounted_cash": 13.63, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD ALCOHOL 70% MEDIUM", "code_information": [{"code": "PHX1007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.04, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD ANTI-SKID TRENDELENBURG WITH BODY STRAPS PRIMEPAD-1S", "code_information": [{"code": "PRIMEPAD-1S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 207.69, "discounted_cash": 124.61, "setting": "both", "billing_class": "facility"}]}, 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"billing_class": "facility"}]}, {"description": "PALM HANDLE  RATCHETING  1/4 QUICK-CONNECT 6067.003", "code_information": [{"code": "6067.003", "type": "CDM"}], "standard_charges": [{"gross_charge": 1829.52, "discounted_cash": 1097.71, "setting": "both", "billing_class": "facility"}]}, {"description": "PALM RATCHET HANDLE 388.654", "code_information": [{"code": "388.654", "type": "CDM"}], "standard_charges": [{"gross_charge": 3332.88, "discounted_cash": 1999.73, "setting": "both", "billing_class": "facility"}]}, {"description": "PALMAR FASCIECTOMY PALM ONLY 26121", "code_information": [{"code": "26121", "type": "CPT"}, {"code": "1481527", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALMAR FASCIETOMY PALM PARTIAL 26123", "code_information": [{"code": "26123", "type": "CPT"}, {"code": "1481528", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALMAR FASCIOTOMY 26040", "code_information": [{"code": "26040", "type": "CPT"}, {"code": "1481529", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALMAR FASCIOTOMY OPEN/PARTIAL 26045", "code_information": [{"code": "26045", "type": "CPT"}, {"code": "1481530", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREAS REMOVAL/TRANSPLANT", "code_information": [{"code": "48160", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREAS TRANSPLANT", "code_information": [{"code": "10", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 54.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 59.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 44.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "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": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC", "code_information": [{"code": "406", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20791.28, "maximum": 31852.87, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 31852.87, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 20791.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC", "code_information": [{"code": "405", "type": "MS-DRG"}], "standard_charges": [{"minimum": 39482.59, "maximum": 61572.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 61572.32, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 39482.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "407", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14729.91, "maximum": 24224.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 24224.24, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14729.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48146", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48152", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48153", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48154", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATORRHAPHY", "code_information": [{"code": "48545", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANGEA LOCKING CAP DRIVER WITH RELEASE/LONG 03.620.059", "code_information": [{"code": "3.620.059", "type": "CDM"}], "standard_charges": [{"gross_charge": 6605.28, "discounted_cash": 3963.17, "setting": "both", "billing_class": "facility"}]}, {"description": "PANGEATM HOOK HOLDING FORCEPS-CURVED 03.622.042", "code_information": [{"code": "3.622.042", "type": "CDM"}], "standard_charges": [{"gross_charge": 1178.38, "discounted_cash": 707.03, "setting": "both", "billing_class": "facility"}]}, {"description": "PANGEATM HOOK HOLDING FORCEPS-LATERAL 03.622.040", "code_information": [{"code": "3.622.040", "type": "CDM"}], "standard_charges": [{"gross_charge": 1178.38, "discounted_cash": 707.03, "setting": "both", "billing_class": "facility"}]}, {"description": "PANGEATM HOOK HOLDING FORCEPS-STRAIGHT 03.622.041", "code_information": [{"code": "3.622.041", "type": "CDM"}], "standard_charges": [{"gross_charge": 1178.38, "discounted_cash": 707.03, "setting": "both", "billing_class": "facility"}]}, {"description": "PANGEATM LOCKING CAP DRIVER WITH KNURLED HANDLE 03.622.016", "code_information": [{"code": "3.622.016", "type": "CDM"}], "standard_charges": [{"gross_charge": 1375.92, "discounted_cash": 825.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PANGEATM LOCKING CAP DRIVER WITH RELEASE 03.620.029", "code_information": [{"code": "3.620.029", "type": "CDM"}], "standard_charges": [{"gross_charge": 6322.32, "discounted_cash": 3793.39, "setting": "both", "billing_class": "facility"}]}, {"description": "PANGEATM LOCKING CAP DRIVER WITH T-HANDLE 03.620.013", "code_information": [{"code": "3.620.013", "type": "CDM"}], "standard_charges": [{"gross_charge": 1859.76, "discounted_cash": 1115.86, "setting": "both", "billing_class": "facility"}]}, {"description": "PANGEATM LOCKING CAP DRIVER WITH T-HANDLE/LONG 03.620.043", "code_information": [{"code": "3.620.043", "type": "CDM"}], "standard_charges": [{"gross_charge": 1846.8, "discounted_cash": 1108.08, "setting": "both", "billing_class": "facility"}]}, {"description": "PANGEATM REMOBILIZATION TOOL 03.620.014", "code_information": [{"code": "3.620.014", "type": "CDM"}], "standard_charges": [{"gross_charge": 5177.52, "discounted_cash": 3106.51, "setting": "both", "billing_class": "facility"}]}, {"description": "PANNICULECTOMY 15830", "code_information": [{"code": "15830", "type": "CPT"}, {"code": "1481537", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 14275.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANORAMIC X-RAY OF JAWS", "code_information": [{"code": "70355", "type": "CPT"}], "standard_charges": 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"standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 129.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 260.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 260.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 274.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 247.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 183.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 380.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 323.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANT INCONTINENT PREMIUM 20-60 MD LG MSC86300", "code_information": [{"code": "MSC86300", 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{"description": "PARACENTESIS OF ANTERIOR CHAMBER OF EYE;WITH THERAPEUTIC RELEASE OF AQUEOUS 65805", "code_information": [{"code": "1481541", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PARAINFLUENZA AG IF", "code_information": [{"code": "87279", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee 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1172.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2354.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2354.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2478.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2230.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1660.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARATHYROID PLANAR IMAGING", "code_information": [{"code": "78070", "type": "CPT"}], "standard_charges": [{"minimum": 892.34, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No 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"standard_charge_dollar": 892.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1792.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1792.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1886.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1697.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1264.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARATHYROIDECTOMY 60500", "code_information": [{"code": "60500", "type": "CPT"}, {"code": "1481542", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3986.0, "maximum": 9519.0, "gross_charge": 16566.0, 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARAVAGINAL DEFECT REPAIR;VAGINAL APPROACH 57285", "code_information": [{"code": "57285", "type": "CPT"}, {"code": "1481545", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 10329.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", 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"plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARING OR CUTTING OF BENIGN LESION 4+ 11057", "code_information": [{"code": "11057", "type": "CPT"}, 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARING OR CUTTING OF BENIGN SINGLE LESION 11055", "code_information": [{"code": "11055", "type": "CPT"}, {"code": "1481548", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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{"description": "PARTIAL PROCTECTOMY", "code_information": [{"code": "45123", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47141", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47142", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for 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"standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44140", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44141", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44143", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for 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"standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44144", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee 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"maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43118", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": 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{"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HEART SAC", "code_information": [{"code": "33031", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF KIDNEY", "code_information": [{"code": "50240", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31367", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31368", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee 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"CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31370", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31375", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31380", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LUNG", "code_information": [{"code": "32480", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48140", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48150", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PHARYNX", "code_information": [{"code": "42890", "type": "CPT"}], "standard_charges": [{"minimum": 3869.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45114", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RIB", "code_information": [{"code": "21600", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RIB", "code_information": [{"code": "21610", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 91.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 82.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 61.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 31.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"standard_charges": [{"gross_charge": 7800.0, "discounted_cash": 4680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK XL - 14X18X60MM 6914860", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6914860", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK XLL - 10X18X40MM   10DEG 6981040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6981040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK XLL - 10X18X45MM   10DEG 6981045", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6981045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK XLL - 10X18X50MM   10DEG 6981050", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6981050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13676.0, "discounted_cash": 8205.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK XLL - 12X18X40MM   10DEG 6981240", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6981240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK XLL - 14X18X45MM   10DEG 6981445", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6981445", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK XLL - 14X18X50MM  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{"code": "6981655", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK XLL - 8X18X55MM   10DEG 6980855", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6980855", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13676.0, "discounted_cash": 8205.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK XLW - 10X22X45MM 6910245", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6910245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK XLW - 14X22X55MM 6914255", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6914255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK XLW - 14X22X60MM 6914260", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6914260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK XLWL - 10X22X45MM   10DEG 6921045", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6921045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK XLWL - 12X22X60MM   10DEG 6921260", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6921260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10400.0, "discounted_cash": 6240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK XLWL - 14X22X50MM   10DEG 6921450", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6921450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK XLWL - 14X22X55MM   10DEG 6921455", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6921455", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK XLWL - 14X22X60MM   10DEG 6921460", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6921460", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEEK XLWL - 16X22X60MM   10DEG 6921660", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "6921660", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEELK IMPLANT COHERE XL 12X18X50MM  8181250P2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8181250P2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12480.0, "discounted_cash": 7488.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG 14MM X 2.3MM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-S2314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 444.0, "discounted_cash": 266.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG 2.3 X 18MM CRUCIFORM LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-S2318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 444.0, "discounted_cash": 266.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG BONE 28MM X 8MM PATELLA STANDARD VANGUARD 3 IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "184762", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2631.2, "discounted_cash": 1578.72, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG CAR ANGL LOCKING 1.8MM X 14.0MM", "code_information": [{"code": "FLP-114", "type": "CDM"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 324.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG CAR ANGL LOCKING 1.8MM X 16.0MM", "code_information": [{"code": "FLP-116", "type": "CDM"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 324.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG CAR ANGL LOCKING 1.8MM X 18.0MM", "code_information": [{"code": "FLP-118", "type": "CDM"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 324.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG CAR ANGL LOCKING 1.8MM X 20.0MM", "code_information": [{"code": "FLP-120", "type": "CDM"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 324.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG CAR ANGL LOCKING 1.8MM X 22.0MM", "code_information": [{"code": "FLP-122", "type": "CDM"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 324.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG CAR ANGL LOCKING 1.8MM X 24.0MM", "code_information": [{"code": "FLP-124", "type": "CDM"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 324.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG CAR ANGL LOCKING 1.8MM X 26.0MM", "code_information": [{"code": "FLP-126", "type": "CDM"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 324.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG COMPRESSION 12MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "144-42112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2240.0, "discounted_cash": 1344.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG CORTICAL 2.3MM X 16MM SMOOTH LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-S2316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 444.0, "discounted_cash": 266.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG CRUCIFORM LOCKING 2.3 X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-S2320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 336.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG CRUCIFORM LOCKING 2.3 X 22MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "CO-S2322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 336.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG FEMORAL PS COCRMO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6515.09.900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG HIGH COMP LOCKING  2.7MM X 16MM  TI HCLP-27160-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCLP-27160-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 415.8, "discounted_cash": 249.48, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG HIGH COMP LOCKING  2.7MM X 18MM  TI HCLP-27180-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCLP-27180-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 415.8, "discounted_cash": 249.48, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG HIGH COMP LOCKING  2.7MM X 19MM HCLP-27190-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCLP-27190-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 415.8, "discounted_cash": 249.48, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG HIGH COMP LOCKING  2.7MM X 20MM  TI HCLP-27200-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCLP-27200-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 415.8, "discounted_cash": 249.48, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG HIGH COMP LOCKING  2.7MM X 21MM HCLP-27210-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HCLP-27210-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 415.8, "discounted_cash": 249.48, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG INTERFERON ALFA-2A/180", "code_information": [{"code": "S0145", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEG INTERFERON ALFA-2B/10", "code_information": [{"code": "S0148", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEG PSN TIBIA 2 SZ X C L 42-5300-064-01", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5300-064-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1687.5, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH  LOCKING  2.0MM X 12MM SPLS-20120-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20120-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 237.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH  LOCKING  2.0MM X 14MM SPLS-20140-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20140-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 237.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH  LOCKING  2.0MM X 16MM SPLS-20160-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20160-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 237.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH  LOCKING  2.0MM X 17MM SPLS-20170-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20170-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 237.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH  LOCKING  2.0MM X 18MM SPLS-20180-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20180-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 237.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH  LOCKING  2.0MM X 19MM SPLS-20190-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20190-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 415.8, "discounted_cash": 249.48, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH  LOCKING  2.0MM X 20MM SPLS-20200-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20200-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 237.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH  LOCKING  2.0MM X 21MM SPLS-20210-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20210-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 237.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG SMOOTH  LOCKING  2.0MM X 22MM SPLS-20220-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPLS-20220-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 237.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  CORTICAL NON-LOCKING  2.7MM X 10MM  TI PANL-27100-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PANL-27100-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 624.0, "discounted_cash": 374.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  CORTICAL NON-LOCKING  2.7MM X 12MM  TI PANL-27120-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PANL-27120-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 624.0, "discounted_cash": 374.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  CORTICAL NON-LOCKING  2.7MM X 16MM  TI PANL-27160-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PANL-27160-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 555.0, "discounted_cash": 333.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  CORTICAL NON-LOCKING  2.7MM X 18MM 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"standard_charges": [{"gross_charge": 396.0, "discounted_cash": 237.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  NON-LOCKING  2.7MM X 12MM  TI TPNL-27120-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27120-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 237.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  NON-LOCKING  2.7MM X 14MM  TI TPNL-27140-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27140-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 415.8, "discounted_cash": 249.48, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  NON-LOCKING  2.7MM X 16MM  TI TPNL-27160-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27160-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": 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415.8, "discounted_cash": 249.48, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  NON-LOCKING  2.7MM X 24MM  TI TPNL-27240-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27240-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 415.8, "discounted_cash": 249.48, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  NON-LOCKING  2.7MM X 26MM  TI TPNL-27260-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27260-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 415.8, "discounted_cash": 249.48, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  NON-LOCKING  2.7MM X 28MM  TI TPNL-27280-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27280-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 415.8, "discounted_cash": 249.48, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  NON-LOCKING  2.7MM X 30MM  TI TPNL-27300-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27300-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 415.8, "discounted_cash": 249.48, "setting": "both", "billing_class": "facility"}]}, {"description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC", "code_information": [{"code": "734", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16925.31, "maximum": 23849.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 23849.96, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16925.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PELVIC EVISCERATION, 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"standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC EXENTERATION", "code_information": [{"code": "45126", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC EXENTERATION 58240", "code_information": [{"code": "58240", "type": "CPT"}, {"code": "1481574", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC FIXATION OTHER THAN SACRUM 22848", "code_information": [{"code": "22848", "type": "CPT"}, {"code": "22140355", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 14483.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC RING FRACTURE UNI/BIL", "code_information": [{"code": "G0413", "type": "HCPCS"}], "standard_charges": [{"minimum": 3344.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC RING FX TREAT INT FIX", "code_information": [{"code": "G0414", "type": "HCPCS"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEN BIPOLAR FINE TIP 23G", "code_information": [{"code": "20-2310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 102.17, "discounted_cash": 61.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PEN CAUTERY BIPOLAR 25 GA FINE TIP", "code_information": [{"code": "20-2530", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.73, "discounted_cash": 21.44, "setting": "both", "billing_class": "facility"}]}, {"description": "PEN NEEDLES AUTOSHIELD DUO SAFETY B-D329515Z", "code_information": [{"code": "B-D329515Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.82, "discounted_cash": 1.69, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL BIPOLAR 25GA STRAIGHT FOR VITRECTOMY PROCEDURE DISP", "code_information": [{"code": "14-5011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 168.3, "discounted_cash": 100.98, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL CAUTERY FINE TIP HIGH DISP", "code_information": [{"code": "65410-181", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.62, "discounted_cash": 34.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL CAUTERY HOLSTER ELECTROSURGICAL LFINSTR DISP", "code_information": [{"code": "E2516H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.61, "discounted_cash": 34.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ELCTRD .093IN X 10FT CORD BLD HLSTR ROCKER SWITCH W/ ACCUVAC SMOKE EVACUA", "code_information": [{"code": "E2515HS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.5, "discounted_cash": 24.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ELECTROSURGICAL 10FT 2.4MM HANDSWITCH LFINSTR DISP", "code_information": [{"code": "E2515", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.17, "discounted_cash": 33.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ELECTROSURGICAL 10FT X .093IN SMOKE EVACUATION W/ 1IN STAINLESS STEEL BLA", "code_information": [{"code": "E2516HS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.5, "discounted_cash": 24.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ELECTROSURGICAL 10FTFT SWITCH LOCK BLADE STRL DISP", "code_information": [{"code": "E2504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 12.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ELECTROSURGICAL HANDSWITCH PUSH BTN", "code_information": [{"code": "E2516", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.58, "discounted_cash": 32.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ELECTROSURGICAL ROCKER HANDSWITCH COATED BLADE DISP", "code_information": [{"code": "E2450H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.49, "discounted_cash": 43.49, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL FORCE TRIVERSE", "code_information": [{"code": "FT3000DB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.16, "discounted_cash": 96.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL HAND ROCKER W/HOLSTER CTD BLA E2350H", "code_information": [{"code": "E2350H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.14, "discounted_cash": 34.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ROCKER SWITCH W HOLSTER E2515H", "code_information": [{"code": "E2515H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.72, "discounted_cash": 8.83, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCILTUBINGBOVIE W/SMOKE EVAC E2350HS E2350HS", "code_information": [{"code": "E2350HS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.2, "discounted_cash": 35.52, "setting": "both", "billing_class": "facility"}]}, {"description": "PENETRATING AWL 64416006A", "code_information": [{"code": "64416006A", "type": "CDM"}], "standard_charges": [{"gross_charge": 1242.22, "discounted_cash": 745.33, "setting": "both", "billing_class": "facility"}]}, {"description": "PENILE INJECTION", "code_information": [{"code": "54235", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENILE VASCULAR STUDY", "code_information": [{"code": "93980", "type": "CPT"}], "standard_charges": [{"minimum": 397.64, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENILE VASCULAR STUDY", "code_information": [{"code": "93981", "type": "CPT"}], "standard_charges": [{"minimum": 397.64, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENILE VENOUS OCCLUSION", "code_information": [{"code": "37790", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENIS PROCEDURES WITH CC/MCC", "code_information": [{"code": "709", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14913.41, "maximum": 25486.61, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 25486.61, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14913.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "710", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12254.13, "maximum": 17028.88, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 17028.88, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12254.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS STUDY", "code_information": [{"code": "54240", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENIS STUDY", "code_information": [{"code": "54250", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENTALOBE DRIVER 03.611.083", "code_information": [{"code": "3.611.083", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 284.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PER PM REEVAL EST PAT 65+ YR", "code_information": [{"code": "99397", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PER PM REEVAL EST PAT INFANT", "code_information": [{"code": "99391", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC BX BREAST LESIONS MR", "code_information": [{"code": "C7502", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC BX BREAST LESIONS STERO", "code_information": [{"code": "C7501", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC CHRO ADD", "code_information": [{"code": "C9608", "type": "HCPCS"}], "standard_charges": [{"minimum": 1105.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC CHRO SIN", "code_information": [{"code": "C9607", "type": "HCPCS"}], "standard_charges": [{"minimum": 8928.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC T CABG B", "code_information": [{"code": "C9605", "type": "HCPCS"}], "standard_charges": [{"minimum": 1105.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC T CABG S", "code_information": [{"code": "C9604", "type": "HCPCS"}], "standard_charges": [{"minimum": 6752.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC W AMI S", "code_information": [{"code": "C9606", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR STENT ATHER BR", "code_information": [{"code": "C9603", "type": "HCPCS"}], "standard_charges": [{"minimum": 1105.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR STENT ATHER S", "code_information": [{"code": "C9602", "type": "HCPCS"}], "standard_charges": [{"minimum": 8928.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC DRUG-EL COR STENT BRAN", "code_information": [{"code": "C9601", "type": "HCPCS"}], "standard_charges": [{"minimum": 1105.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC DRUG-EL COR STENT SING", "code_information": [{"code": "C9600", "type": "HCPCS"}], "standard_charges": [{"minimum": 6752.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC RF ABLATE RENAL TUMOR", "code_information": [{"code": "50592", "type": "CPT"}], "standard_charges": [{"minimum": 3004.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE 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"plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUT ABLATE LIVER RF", "code_information": [{"code": "47382", "type": "CPT"}], "standard_charges": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIACETABULAR OSTEOTOMY", "code_information": [{"code": "S2115", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, 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SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIOSTEAL ELEVATOR 08-619", "code_information": [{"code": "8-619", "type": "CDM"}], "standard_charges": [{"gross_charge": 1328.4, "discounted_cash": 797.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITH CC", "code_information": [{"code": "300", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7513.96, "maximum": 12142.75, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 12142.75, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7513.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITH MCC", "code_information": [{"code": "299", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10645.94, "maximum": 18346.82, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 18346.82, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10645.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "301", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5330.31, "maximum": 8091.38, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 8091.38, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5330.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR REHAB", "code_information": [{"code": "93668", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR", "code_information": [{"code": "41", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16433.0, "maximum": 35154.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 25612.5, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 20090.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 31983.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 16433.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 27186.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 35154.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 17310.66, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 23471.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 22297.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 21124.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 19950.0, "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": 16433.0, "maximum": 42783.16, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 42783.16, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 20090.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 31983.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 16433.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 27186.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 35154.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 28832.99, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 23471.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 22297.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 21124.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 19950.0, "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": 13736.81, "maximum": 35154.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 19934.7, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 20090.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 31983.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 16433.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 27186.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 35154.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13736.81, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 23471.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 22297.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 21124.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 19950.0, "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": 496.09, "discounted_cash": 297.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITH CC", "code_information": [{"code": "336", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16868.79, "maximum": 23957.71, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 23957.71, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16868.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITH MCC", "code_information": [{"code": "335", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29815.08, "maximum": 41096.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 41096.6, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 29815.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC", "code_information": [{"code": "337", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11768.22, "maximum": 17411.1, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 17411.1, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11768.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERITONEAL LAVAGE", "code_information": [{"code": "49084", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERM FLP TUBE OCCLS W/IMPLT", "code_information": [{"code": "567T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 6734.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC", "code_information": [{"code": "243", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16240.0, "maximum": 31604.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 25551.26, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 19855.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 31604.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 16240.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 26864.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 29293.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 18748.56, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 23195.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 22035.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 20876.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 19716.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC", "code_information": [{"code": "242", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16240.0, "maximum": 38472.06, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 38472.06, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 19855.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 31604.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 16240.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 26864.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 29293.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 27428.85, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 23195.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 22035.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 20876.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 19716.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC", "code_information": [{"code": "244", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15493.27, "maximum": 31604.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 20468.91, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 19855.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 31604.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 16240.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 26864.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 29293.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 15493.27, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 23195.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 22035.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 20876.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 19716.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ & ICUT ALLG TEST VENOMS", "code_information": [{"code": "95017", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ ABLTJ LVR CRYOABLATION", "code_information": [{"code": "47383", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ ACCESS & CLSR FEM ART", "code_information": [{"code": "34713", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3330.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4892.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6688.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6336.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4717.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ ART M-THROMBECT &/NFS", "code_information": [{"code": "61645", "type": "CPT"}], 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"standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ CLSR TCAT L ATR APNDGE", "code_information": [{"code": "33340", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ CVT&LS INJ VERT BODIES", "code_information": [{"code": "C7504", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST MR GUIDE", "code_information": [{"code": "19287", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD MR GUIDE", "code_information": [{"code": "19288", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD STRTCTC", "code_information": [{"code": "19284", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD US IMAG", "code_information": [{"code": "19286", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEVICE BREAST 1ST IMAG", "code_information": [{"code": "19281", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEVICE BREAST EA IMAG", "code_information": [{"code": "19282", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ IMPLTJ/RPLCMT ISDNS PTN", "code_information": [{"code": "587T", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ ISLET CELL TRANSPLANT", "code_information": [{"code": "584T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ LAMOT/LAM CRV/THRC", "code_information": [{"code": "274T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ LAMOT/LAM LUMBAR", "code_information": [{"code": "275T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ LS&CVT INJ VERT BODIES", "code_information": [{"code": "C7505", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ LUMB&THOR VERT AUG", "code_information": [{"code": "C7508", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC CT LMBR 1ST", "code_information": [{"code": "629T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC CT LMBR EA", "code_information": [{"code": "630T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC FLUOR LMBR 1ST", "code_information": [{"code": "627T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC FLUOR LMBR EA", "code_information": [{"code": "628T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 ABNOR BI", "code_information": [{"code": "33903", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 ABNOR UNI", "code_information": [{"code": "33902", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 NM NT BI", "code_information": [{"code": "33901", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 NM NT UNI", "code_information": [{"code": "33900", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC EACH ADDL", "code_information": [{"code": "33904", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47538", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47539", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47540", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ PRCRD DRG INSJ CATH CT", "code_information": [{"code": "33019", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ SACRAL AUGMT BILAT INJ", "code_information": [{"code": "201T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ SACRAL AUGMT UNILAT INJ", "code_information": [{"code": "200T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ STENT/CHEST VERT ART", "code_information": [{"code": "75T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 10872.46, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 5142.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10328.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 10328.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10872.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9785.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 7284.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TCAT ILIAC ANAST IMPLT", "code_information": [{"code": "553T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 6734.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TCAT INTRATRL SEPTL SHT", "code_information": [{"code": "613T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TCAT US ABLTJ NRV P-ART", "code_information": [{"code": "632T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ THOR&LUMB VERT AUG", "code_information": [{"code": "C7507", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLOSURE EACH", "code_information": [{"code": "93592", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLOSURE PDA", "code_information": [{"code": "93582", "type": "CPT"}], "standard_charges": [{"minimum": 3330.0, "maximum": 23180.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3330.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4892.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6688.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6336.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4717.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 13391.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 23180.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLS AORTIC", "code_information": [{"code": "93591", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 37880.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 37880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34092.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLS MITRAL", "code_information": [{"code": "93590", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 37880.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 37880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34092.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH SEPTAL REDUXN", "code_information": [{"code": "93583", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3330.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4892.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6688.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6336.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4717.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRLUML ANGP NT/RECR COA", "code_information": [{"code": "33897", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRLUML CORONRY LITHOTRP", "code_information": [{"code": "92972", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TX MALAR FRACTURE", "code_information": [{"code": "21355", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TX NASOETHMOID FX", "code_information": [{"code": "21340", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ&IC ALLG TEST DRUGS/BIOL", "code_information": [{"code": "95018", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PERSONALIZED KNEE SYSTEM RIGHT 12MM HEIGHT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5226-005-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4420.0, "discounted_cash": 2652.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PERSUADER 03.614.027", "code_information": [{"code": "3.614.027", "type": "CDM"}], "standard_charges": [{"gross_charge": 7516.8, "discounted_cash": 4510.08, "setting": "both", "billing_class": "facility"}]}, {"description": "PERSUADER 03.616.013", "code_information": [{"code": "3.616.013", "type": "CDM"}], "standard_charges": [{"gross_charge": 11460.96, "discounted_cash": 6876.58, "setting": "both", "billing_class": "facility"}]}, {"description": "PERSUADER 03.616.056", "code_information": [{"code": "3.616.056", "type": "CDM"}], "standard_charges": [{"gross_charge": 10713.6, "discounted_cash": 6428.16, "setting": "both", "billing_class": "facility"}]}, {"description": "PERSUADER FOR AXONTM 388.504", "code_information": [{"code": "388.504", "type": "CDM"}], "standard_charges": [{"gross_charge": 4676.4, "discounted_cash": 2805.84, "setting": "both", "billing_class": "facility"}]}, {"description": "PERSUADER FOR STARLOCK 388.036", "code_information": [{"code": "388.036", "type": "CDM"}], "standard_charges": [{"gross_charge": 3205.44, "discounted_cash": 1923.26, "setting": "both", "billing_class": "facility"}]}, {"description": "PERTUSSIS AG IF", "code_information": [{"code": "87265", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 78.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 158.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 158.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 166.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 150.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 111.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 29.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PESTLE 2570019 LOOP BONE PESTLE 2570019", "code_information": [{"code": "2570019", "type": "CDM"}], "standard_charges": [{"gross_charge": 355.5, "discounted_cash": 213.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PESTLE 2670008 WAVE PESTLE 2670008", "code_information": [{"code": "2670008", "type": "CDM"}], "standard_charges": [{"gross_charge": 339.16, "discounted_cash": 203.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PET IMAGE FULL BODY", "code_information": [{"code": "78813", "type": "CPT"}], "standard_charges": [{"minimum": 2148.98, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2148.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4316.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 4316.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4543.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 4088.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 3044.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE LTD AREA", "code_information": [{"code": "78811", "type": "CPT"}], "standard_charges": [{"minimum": 1976.65, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1976.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3970.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3970.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4178.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3761.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2799.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE SKULL-THIGH", "code_information": [{"code": "78812", "type": "CPT"}], "standard_charges": [{"minimum": 2148.98, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2148.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4316.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 4316.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4543.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 4088.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 3044.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE W/CT FULL BODY", "code_information": [{"code": "78816", "type": "CPT"}], "standard_charges": [{"minimum": 2906.51, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2906.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5837.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 5837.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6144.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5530.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4117.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE W/CT LMTD", "code_information": [{"code": "78814", "type": "CPT"}], "standard_charges": [{"minimum": 1840.28, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1840.28, "methodology": "fee 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2606.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE W/CT SKULL-THIGH", "code_information": [{"code": "78815", "type": "CPT"}], "standard_charges": [{"minimum": 2218.08, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": 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2067.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PHALINX IMPLANT CANNULATED STRAIGHT TI SZ SM  0* ANGLE 45A01002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "45A01002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5707.0, "discounted_cash": 3424.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PHANTOM FIBER BIOFIBER SUTURE - NON-NEEDLED TIPPED - SIZE 2  36  VIOLET -QTY OF 1 SMSB0120", "code_information": [{"code": "SMSB0120", "type": "CDM"}], "standard_charges": [{"gross_charge": 208.56, "discounted_cash": 125.14, "setting": "both", "billing_class": "facility"}]}, {"description": "PHANTOM FIBER BIOFIBER SUTURE - NON-NEEDLED TIPPED - SIZE 2  36  VIOLET/WHITE -QTY OF 1 SMSB0130", "code_information": [{"code": "SMSB0130", "type": "CDM"}], "standard_charges": [{"gross_charge": 208.56, "discounted_cash": 125.14, "setting": "both", "billing_class": "facility"}]}, {"description": "PHANTOM FIBER BIOFIBER SUTURE - NON-NEEDLED TIPPED - SIZE 2  36  WHITE -QTY OF 1 SMSB0110", "code_information": [{"code": "SMSB0110", "type": "CDM"}], "standard_charges": [{"gross_charge": 208.56, "discounted_cash": 125.14, "setting": "both", "billing_class": "facility"}]}, {"description": "PHANTOM XL DILATOR CLIP ML-0345", "code_information": [{"code": "ML-0345", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 458.74, "discounted_cash": 275.24, "setting": "both", "billing_class": "facility"}]}, {"description": "PHARMACOLOGIC MGMT W/PSYTX", "code_information": [{"code": "90863", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHARMACY COMP/DISP SERV", "code_information": [{"code": "S9430", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PHARYNGOPLASTY 42950", "code_information": [{"code": "42950", 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[{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH CAROTID/INOM ART", "code_information": [{"code": "36222", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee 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CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH INTRACRANIAL ART", "code_information": [{"code": "36228", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH SUBCLAVIAN ART", 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH THORACIC AORTA", "code_information": [{"code": "36221", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36013", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36014", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36015", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee 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for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36217", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36218", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 9519.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36010", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36011", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36012", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee 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"plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CECOSTOMY TUBE PERC", "code_information": [{"code": "49442", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE DUOD/JEJ TUBE PERC", "code_information": [{"code": "49441", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43831", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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[{"code": "43832", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE PERC", "code_information": [{"code": "49440", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE NDL MUSC/TIS FOR RT", "code_information": [{"code": "20555", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLES H&N FOR RT", "code_information": [{"code": "41019", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLES PELVIC FOR RT", "code_information": [{"code": "55920", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE PERM PACING CARDIOVERT", "code_information": [{"code": "G0448", "type": "HCPCS"}], "standard_charges": [{"minimum": 1483.0, "maximum": 6734.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE PO BREAST CATH FOR RAD", "code_information": [{"code": "19296", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 90.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 81.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 60.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 167.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 337.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 337.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 368.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 368.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 388.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 349.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 260.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 53.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 45.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELET CONCENTRATION SYSTEM GPS III  800-1004A", "code_information": [{"code": "800-1004A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1531.79, "discounted_cash": 919.07, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATELET DEPLETE OF HARVEST", "code_information": [{"code": "38213", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELET SURVIVAL", "code_information": [{"code": "78191", "type": "CPT"}], "standard_charges": [{"minimum": 311.97, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 311.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 626.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 626.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 659.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 593.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 441.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELETS, LEUKOCYTES REDUCED, IRRADIATED; EACH UNIT P9033", "code_information": [{"code": "P9033", "type": "HCPCS"}, {"code": "45850891", "type": "CDM"}, {"code": "384", "type": "RC"}], "standard_charges": [{"gross_charge": 653.49, "discounted_cash": 392.09, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATFORM ACCESS SNGLINCISION W/ GELSEAL CAP ALEXIS WOUND PROTECTOR RETRACTOR 10", "code_information": [{"code": "CNGL2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1501.74, "discounted_cash": 901.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATING STRAIGHT M6 HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ANC588/M6", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2357.6, "discounted_cash": 1414.56, "setting": "both", "billing_class": "facility"}]}, {"description": "PLCG2 GENE COMMON VARIANTS", "code_information": [{"code": "81320", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 853.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 725.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLEDGET CARDIOVASCULAR 4IN X 1/2IN X 5/16IN X 1/16IN DEKNATEL SOFT PTFE STRL", "code_information": [{"code": "X4544", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.2, "discounted_cash": 31.32, "setting": "both", "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITH CC", "code_information": [{"code": "187", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7736.36, "maximum": 11387.37, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11387.37, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7736.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITH MCC", "code_information": [{"code": "186", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11446.73, "maximum": 17920.36, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 17920.36, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11446.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITHOUT CC/MCC", "code_information": [{"code": "188", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5631.25, "maximum": 8327.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 8327.3, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5631.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLIF CAGE 9 X 26 X 14MM TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PSTS-SM0614-26-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10400.0, "discounted_cash": 6240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLIF GRAFT PUSHER 394.571", "code_information": [{"code": "394.571", "type": "CDM"}], "standard_charges": [{"gross_charge": 923.02, "discounted_cash": 553.81, "setting": "both", "billing_class": "facility"}]}, {"description": "PLIF IMPACTOR 389.103", "code_information": [{"code": "389.103", "type": "CDM"}], "standard_charges": [{"gross_charge": 2890.08, "discounted_cash": 1734.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PLIF OSTEOTOME 5MM WIDTH/140MM LENGTH 389.125", "code_information": [{"code": "389.125", "type": "CDM"}], "standard_charges": [{"gross_charge": 1189.02, "discounted_cash": 713.41, "setting": "both", "billing_class": "facility"}]}, {"description": "PLIF RECTANGULAR BONE CURETTE 8MM WIDTH/140MM LENGTH 389.124", "code_information": [{"code": "389.124", "type": "CDM"}], "standard_charges": [{"gross_charge": 1432.08, "discounted_cash": 859.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLMT ACCESS BIL TREE SM BWL", "code_information": [{"code": "47541", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT BILIARY DRAINAGE CATH", "code_information": [{"code": "47533", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT BILIARY DRAINAGE CATH", "code_information": [{"code": "47534", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT ADDL", "code_information": [{"code": "222T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 4173.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT CERV", "code_information": [{"code": "219T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT LUMB", "code_information": [{"code": "221T", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT THOR", "code_information": [{"code": "220T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT SFT TISS LOCLZJ DEV 1ST", "code_information": [{"code": "10035", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT SFT TISS LOCLZJ DEV EA", "code_information": [{"code": "10036", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50694", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50695", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT XTN PROSTH EVASC RPR", "code_information": [{"code": "34709", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLNNING PT SPEC FENEST GRAFT", "code_information": [{"code": "34839", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLS AIMING GUIDES PLS-AIM-0910", "code_information": [{"code": "PLS-AIM-0910", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 164.32, "discounted_cash": 98.59, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG ADAPTER MALE PORT LIFESHIELD MICROCLAVE", "code_information": [{"code": "1256801", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 8.5, "discounted_cash": 5.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG ADAPTOR CLAVE LIFESHIELD STERILE 11956-01", "code_information": [{"code": "11956-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.59, "discounted_cash": 4.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG CANAL MED 11MM TO 13MM CANALINTRAMEDULLARY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "130611", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 528.0, "discounted_cash": 316.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG CANAL SMINTRAMEDULLARY FOR 8 MM - 10 MM CANAL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "130609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 528.0, "discounted_cash": 316.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG CANAL XL 18MM TO 21MMINTRAMEDULLARY", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "130615", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 328.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG CANCELLOUS 10MM CERVICAL", "code_information": [{"code": "FD57908U", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6997.62, "discounted_cash": 4198.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG CATHETER DRAINAGE PROTECTOR 000076", "code_information": [{"code": "76", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.92, "discounted_cash": 1.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG CERVICAL 6MM CANCELLOUS IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "FD57906U", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6997.62, "discounted_cash": 4198.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG CERVICAL 7MM CANCELLOUS IMP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "FD57907U", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6997.62, "discounted_cash": 4198.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG INTREMEDULLARY LGE 130613", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "130613", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 528.0, "discounted_cash": 316.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG MESH MED 12 CM X 7.5 CM MED 4 CM HERNIA REPAIR ULTRAPRO", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "UPPM2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 817.56, "discounted_cash": 490.54, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG SCLERAL 20GA 19GA DISP", "code_information": [{"code": "5078", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.73, "discounted_cash": 63.44, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG SURG 2X1.5IN LGHT PRFX XL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "117080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1322.4, "discounted_cash": 793.44, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUG TAPER TI REV KNEE SYS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "2472-0-0000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 924.0, "discounted_cash": 554.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUNGER  7MM 693.412", "code_information": [{"code": "693.412", "type": "CDM"}], "standard_charges": [{"gross_charge": 366.56, "discounted_cash": 219.94, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUNGER - TRIAL  8.5MM 693.414", "code_information": [{"code": "693.414", "type": "CDM"}], "standard_charges": [{"gross_charge": 484.12, "discounted_cash": 290.47, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUNGER 7509004 SMALL FLEX 7509004", "code_information": [{"code": "7509004", "type": "CDM"}], "standard_charges": [{"gross_charge": 1209.6, "discounted_cash": 725.76, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUNGER 7509012 MEDIUM FLEX 7509012", "code_information": [{"code": "7509012", "type": "CDM"}], "standard_charges": [{"gross_charge": 1209.6, "discounted_cash": 725.76, "setting": "both", "billing_class": "facility"}]}, {"description": "PM DEVICE PROGR EVAL DUAL", "code_information": [{"code": "93280", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO 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"AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PM PHONE R-STRIP DEVICE EVAL", "code_information": [{"code": "93293", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH 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schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 607.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 515.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PML/RARALPHA COM BREAKPOINTS", "code_information": [{"code": "81315", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 329.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 661.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 661.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 696.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 626.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 466.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 607.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 515.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PMP22 GENE DUP/DELET", "code_information": [{"code": "81324", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 524.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1052.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1052.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1108.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 997.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 742.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2220.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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[{"code": "MED0025", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.42, "discounted_cash": 0.25, "setting": "both", "billing_class": "facility"}]}, {"description": "POVIDONE IODINE 10%  OINTMENT 1 GRAM", "code_information": [{"code": "MED0583", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.43, "discounted_cash": 0.26, "setting": "both", "billing_class": "facility"}]}, {"description": "POVIDONE IODINE 30 GRAMS OINTMENT (BETADINE)10%", "code_information": [{"code": "MED0176", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.5, "discounted_cash": 4.5, "setting": "both", "billing_class": "facility"}]}, {"description": "POVIDONE IODINE 5% OPHTH 30ML (BETADINE)", "code_information": [{"code": "MED0177", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 37.15, "discounted_cash": 22.29, "setting": "both", "billing_class": "facility"}]}, {"description": "POVIDONE IODINE 5% OPHTHALMIC SOLUTION 30ML BOTTLE", "code_information": [{"code": "MED0026", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 37.15, "discounted_cash": 22.29, "setting": "both", "billing_class": "facility"}]}, {"description": "POVIDONE IODINE TOP. 10% SOL. 120ML", "code_information": [{"code": "MED0620", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.21, "discounted_cash": 4.93, "setting": "both", "billing_class": "facility"}]}, {"description": "POWDER BARIUM SULFATE 12OZ CONTRAST RAD 250 PCT W/ V BASO4 SUSPENSION FOR EXAMIN", "code_information": [{"code": "901702", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 7.38, "discounted_cash": 4.43, "setting": "both", "billing_class": "facility"}]}, {"description": "POWDER HEMOSTATIC SURGICEL ABSORBABLE", "code_information": [{"code": "3013SP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 468.82, "discounted_cash": 281.29, "setting": "both", "billing_class": "facility"}]}, {"description": "POWDER SURGIFOAM PORCINE STRL 1978", "code_information": [{"code": "1978", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 233.92, "discounted_cash": 140.35, "setting": "both", "billing_class": "facility"}]}, {"description": "POWER BENDER 6041.0506", "code_information": [{"code": "6041.0506", "type": "CDM"}], "standard_charges": [{"gross_charge": 4138.56, "discounted_cash": 2483.14, "setting": "both", "billing_class": "facility"}]}, {"description": "POWER BENDER 6067.0075", "code_information": [{"code": "6067.0075", "type": "CDM"}], "standard_charges": [{"gross_charge": 4968.0, "discounted_cash": 2980.8, "setting": "both", "billing_class": "facility"}]}, {"description": "POWER BENDER 634.506", "code_information": [{"code": "634.506", "type": "CDM"}], "standard_charges": [{"gross_charge": 4762.8, "discounted_cash": 2857.68, "setting": "both", "billing_class": "facility"}]}, {"description": "POWER DRIVER G-WIRE KIT CANNULATED DRIVER T15 G-WIRES 1.1MM X 160MM FIM 015", "code_information": [{"code": "FIM 015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 284.4, "discounted_cash": 170.64, "setting": "both", "billing_class": "facility"}]}, {"description": "POWER GRIP 624.517", "code_information": [{"code": "624.517", "type": "CDM"}], "standard_charges": [{"gross_charge": 8071.92, "discounted_cash": 4843.15, "setting": "both", "billing_class": "facility"}]}, {"description": "POWERPLSE HIP/KNEE DISP UNT W/O SUC 71277005", "code_information": [{"code": "71277005", "type": "CDM"}], "standard_charges": [{"gross_charge": 1225.8, "discounted_cash": 735.48, "setting": "both", "billing_class": "facility"}]}, {"description": "POWERPORT ISP M.R.I. 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRCRD DRG 6YR+ W/O CGEN CAR", "code_information": [{"code": "33017", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRECEPT BLADE   FASCIAL 8801273", "code_information": [{"code": "8801273", "type": "CDM"}], "standard_charges": [{"gross_charge": 1404.0, "discounted_cash": 842.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PREDNISOLONE ACETATE OPHTH SUSP 1% 5ML", "code_information": [{"code": "MED0490", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 103.08, "discounted_cash": 61.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PREMATURITY WITH MAJOR PROBLEMS", "code_information": [{"code": "791", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2945.0, "maximum": 27502.98, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2945.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3182.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 4534.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4773.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 4296.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 3198.0, "methodology": "per diem"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 27502.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3142.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4625.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 4163.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PREMATURITY WITHOUT MAJOR PROBLEMS", "code_information": [{"code": "792", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2258.0, "maximum": 16594.27, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2945.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3182.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 4534.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4773.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"setting": "both", "billing_class": "facility"}]}, {"description": "PREP & CANNULJ CDVR DON LUNG", "code_information": [{"code": "494T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO 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"facility"}]}, {"description": "PREP CADAVER RENAL ALLOGRAFT", "code_information": [{"code": "50323", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP CHLORAPREP 26ML ORANGE STERILE 930815", "code_information": [{"code": "930815", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.11, "discounted_cash": 21.07, "setting": "both", "billing_class": "facility"}]}, {"description": "PREP DONOR INTESTINE/ARTERY", "code_information": [{"code": "44721", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": 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billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER WHOLE", "code_information": [{"code": "47143", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER/ARTERIAL", "code_information": [{"code": "47147", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR PANCREAS", "code_information": [{"code": "48551", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR PANCREAS/VENOUS", "code_information": [{"code": "48552", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF 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"BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP KIT CENTRAL LINE DRESSING (HUBER)", "code_information": [{"code": "DYND75221H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.28, "discounted_cash": 11.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/ARTERIAL", "code_information": [{"code": "50328", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/URETERAL", "code_information": [{"code": "50329", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP TRAY GEL PVP STAND", "code_information": [{"code": "11-Nov", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.45, "discounted_cash": 9.87, "setting": "both", "billing_class": "facility"}]}, {"description": "PREP TRAY WET PVP BTL STAND", "code_information": [{"code": "8-Nov", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.1, "discounted_cash": 13.86, "setting": "both", "billing_class": "facility"}]}, {"description": "PREP TUM CAV IORT PRIM CRNOT", "code_information": [{"code": "735T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARATION FOR BLADDER XRAY", "code_information": [{"code": "51605", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARATION OF REPORT", "code_information": [{"code": "90889", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARATION PALATE MOLD", "code_information": [{"code": "42280", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR HEART", "code_information": [{"code": "33944", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR HEART/LUNG", "code_information": [{"code": "33933", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR INTESTINE", "code_information": [{"code": "44715", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR LUNG DOUBLE", "code_information": [{"code": "32856", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"code_information": [{"code": "89255", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 217.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 435.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 435.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 458.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 412.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 307.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 146.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 124.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21077", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21079", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21082", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21083", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21084", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21086", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21087", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21088", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FECAL MICROBIOTA", "code_information": [{"code": "44705", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE HEART-AORTA CONDUIT", "code_information": [{"code": "33404", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE PENIS STUDY", "code_information": [{"code": "54230", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE SPERM DUCT X-RAY", "code_information": [{"code": "55300", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPJ TUM CAV IORT PRTL MAST", "code_information": [{"code": "19294", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT EST AGE 1-4", "code_information": [{"code": "99392", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT EST AGE 18-39", "code_information": [{"code": "99395", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT EST AGE 40-64", "code_information": [{"code": "99396", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT EST AGE 5-11", "code_information": [{"code": "99393", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT NEW AGE 12-17", "code_information": [{"code": "99384", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY 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"fee schedule"}], "billing_class": "facility"}]}, {"description": "PREVENTIVE COUNSELING GROUP", "code_information": [{"code": "99411", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREVENTIVE COUNSELING GROUP", "code_information": [{"code": "99412", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL IIMS IP", "code_information": [{"code": "528T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL IMPLTBL SYS", "code_information": [{"code": "93260", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL PM/LDLS PM", "code_information": [{"code": "93279", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL SCRMS IP", "code_information": [{"code": "93285", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL WCS IP", "code_information": [{"code": "522T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL IMPLANTABLE DFB", "code_information": [{"code": "93282", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL IMPLANTABLE DFB", "code_information": [{"code": "93283", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVL LDLS PM 1CHMBR IP", "code_information": [{"code": "826T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRIM ART M-THRMBC 1ST VSL", "code_information": [{"code": "37184", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIM ART M-THRMBC SBSQ VSL", "code_information": [{"code": "37185", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee 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HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMARY CHISEL 5MM 03.820.119", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3.820.119", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2013.12, "discounted_cash": 1207.87, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIMARY CHISEL 6MM 03.820.120", "code_information": [{"code": "3.820.120", "type": "CDM"}], "standard_charges": [{"gross_charge": 2013.12, "discounted_cash": 1207.87, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIMARY CHISEL 7MM 03.820.121", "code_information": [{"code": "3.820.121", "type": "CDM"}], "standard_charges": [{"gross_charge": 2013.12, "discounted_cash": 1207.87, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIMARY REPAIR TENDON/MUSCLE EXTENSOR FOREARM/WRIST-SINGLE-EACH TENDON 25270", "code_information": [{"code": "25270", "type": "CPT"}, {"code": "1481628", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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225.62, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE ARTHROSCOPIC ENERGY 90DEG SUCTION 13CM", "code_information": [{"code": "AES-90SC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 376.04, "discounted_cash": 225.62, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE ARTHROSCOPY 50DEG 3.5MM SERFAS ABLATION SUCTION ENERGY RF POSTERIOR KNEE", "code_information": [{"code": "279-351-250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 363.4, "discounted_cash": 218.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE BALL TIP NERVE STIM LAT 11IN", "code_information": [{"code": "2701-90257", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 544.64, "discounted_cash": 326.78, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE BALL TIP STIMULATING AIX1320-S", "code_information": 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"CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2332.35, "discounted_cash": 1399.41, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE ENERGY 3.5MM DIRECT FOR POST AREAS OF THE KNEE AND SHOULDER SERFASINSTR", "code_information": [{"code": "279350401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 466.37, "discounted_cash": 279.82, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE ENERGY RF2 90S", "code_information": [{"code": "279351000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 432.04, "discounted_cash": 259.22, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE ESOPHAGEAL 9FR TEMPERATURE", "code_information": [{"code": "ES400-9", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.14, "discounted_cash": 7.28, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE INCREMENTING 8225825E", "code_information": [{"code": "8225825E", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 457.52, "discounted_cash": 274.51, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE INJ GOLD 10FR 6016", "code_information": [{"code": "6016", "type": "CDM"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE LASER 20G 30DEG CURVED BAYONET ILLUMINATED", "code_information": [{"code": "14410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 369.55, "discounted_cash": 221.73, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE LASER 20GA ASPIRATING SOFT TIP IRIS USE W/ IRIDEX LASER", "code_information": [{"code": "PD720.62", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 369.55, "discounted_cash": 221.73, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE LASER 20GA CURVED ILLUMINATED USE W/ IRIDEX LASER", "code_information": [{"code": "PD720.37A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 369.55, "discounted_cash": 221.73, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE LASER 23G CURVED ILLUMINATED", "code_information": [{"code": "PD723.35SA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 363.4, "discounted_cash": 218.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE LASER 23G HT ASPIRATING", "code_information": [{"code": "BL5293ASPH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 643.72, "discounted_cash": 386.23, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE LASER 23G ILLUMINATED FLEXIBLE CURVED", "code_information": [{"code": "55.70.23", "type": 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MONIPOLAR W/ LOOP ELECTRODE SIDE SHEATH 5MM", "code_information": [{"code": "4155 (ADLER)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 917.39, "discounted_cash": 550.43, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE MONOPOLAR LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8735-1021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 1680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE MONOPOLAR STRAIGHT FLEX 85MM", "code_information": [{"code": "5140-525-608", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE NEURO DISPOSABLE RLBTP201-2.5", "code_information": [{"code": "RLBTP201-2.5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROBE PEDICLE CADWELL", "code_information": [{"code": "C2614", "type": "HCPCS"}, {"code": "320430-000-090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 749.0, "discounted_cash": 449.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE PEDICLE CADWELLINSTR", "code_information": [{"code": "302427-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 777.45, "discounted_cash": 466.47, "setting": "both", "billing_class": 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{"description": "PROCEDURE KIN HYSTEROLUX 72205015", "code_information": [{"code": "72205015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 666.17, "discounted_cash": 399.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PROCEDURE KIT HYSTER. 7209827", "code_information": [{"code": "7209827", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 731.5, "discounted_cash": 438.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PROCEDURE KIT KNOTLESS MONI TR IMPLANT 2.7MM AR-8908DS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8908DS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7040.8, "discounted_cash": 4224.48, "setting": "both", "billing_class": "facility"}]}, {"description": "PROCEDURE MASK INSTAGARD PEDIATRIC", "code_information": [{"code": "AT771212", "type": "CDM"}], "standard_charges": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOPLASTY FOR PROLAPSE OF MUCOUS MEMBRANE 45505", "code_information": [{"code": "45505", "type": "CPT"}, {"code": "1481641", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"billing_class": "facility"}]}, {"description": "PROCTOPLASTY FOR STENOSIS 45500", "code_information": [{"code": "45500", "type": "CPT"}, {"code": "1481642", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY ABLATE", "code_information": [{"code": "45320", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY BLEED", "code_information": [{"code": "45317", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY FB", "code_information": [{"code": "45307", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY W/ REM'L MULTIPLE TUMORS/POLYPS/LESIONS 45315", "code_information": [{"code": "45315", "type": "CPT"}, {"code": "1481623", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY W/ REM'L SINGLE LESION BY HOT BIOPSY FORCEP/BIPOLAR CAUTERY 45308", "code_information": [{"code": "45308", "type": "CPT"}, {"code": "1481625", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY W/ REM'L SINGLE TUMOR/POLYP/LESION BY SNARE 45309", "code_information": [{"code": "45309", "type": "CPT"}, {"code": "1481624", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2505.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2129.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTOZOA ANTIBODY NOS", "code_information": [{"code": "86753", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 52.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 105.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 105.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 111.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 74.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 36.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 30.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROVISC (SODIUM HYALURONATE) 10MG/ML 0.55ML", "code_information": [{"code": "MED0246", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 86.63, "discounted_cash": 51.98, "setting": "both", "billing_class": "facility"}]}, {"description": "PROXIMAL BODY 2.5 12 STD TSS PRIMARY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "BOD-0923-020-12STD", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4110.6, "discounted_cash": 2466.36, "setting": "both", "billing_class": "facility"}]}, {"description": "PROXIMAL BODY TSS 2.5 14LRG PRIMARY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "BOD-0923-020-14LRG", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4110.6, "discounted_cash": 2466.36, "setting": "both", "billing_class": "facility"}]}, {"description": "PRPERTL PEL PACK HEMRRG TRMA", "code_information": [{"code": "49013", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ AV FSTL CRT UXTR SEP ACS", "code_information": [{"code": "36837", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ AV FSTL CRTJ UXTR 1 ACS", "code_information": [{"code": "36836", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD ANGIO/ATHRECT 1 ART", "code_information": [{"code": "92924", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD ANGIO/ATHRECT ADDL", "code_information": [{"code": "92925", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD REVASC CHRONIC 1VSL", "code_information": [{"code": "92943", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD REVASC CHRONIC ADDL", "code_information": [{"code": "92944", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee 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"case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD REVASC MI 1 VSL", "code_information": [{"code": "92941", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee 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"standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD STENT/ATH/ANGIO", "code_information": [{"code": "92933", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", 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"plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARDIAC ANGIO ADDL ART", "code_information": [{"code": "92921", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARDIAC ANGIOPLAST 1 ART", "code_information": [{"code": "92920", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CORONARY MECH THROMBECT", "code_information": [{"code": "92973", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ ELC NRV STIM CN WO IMPLT", "code_information": [{"code": "720T", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ NJX BIOD OSTEO MATRL FEM", "code_information": [{"code": "814T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ REVASC BYP GRAFT 1 VSL", "code_information": [{"code": "92937", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ REVASC BYP GRAFT ADDL", "code_information": [{"code": "92938", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ TCAT THRM ABLT NRV P-ART", "code_information": [{"code": "793T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUL ART BALLOON REPR PERCUT", "code_information": [{"code": "92998", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 15257.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULM DS IPF MRNA 190 GEN ALG", "code_information": [{"code": "81554", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 16163.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 16163.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 13738.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULM FUNCT TST PLETHYSMOGRAP", "code_information": [{"code": "94726", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULM FUNCTION TEST BY GAS", "code_information": [{"code": "94727", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULM TISS VNTJ ALYS PREV CT", "code_information": [{"code": "807T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULM TISS VNTJ ALYS W/CT", "code_information": [{"code": "808T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PULMONARY EDEMA AND RESPIRATORY FAILURE", "code_information": [{"code": "189", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9067.1, "maximum": 14034.59, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 14034.59, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9067.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE", "code_information": [{"code": "175", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10752.37, "maximum": 15982.01, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 15982.01, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10752.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULMONARY EMBOLISM WITHOUT MCC", "code_information": [{"code": "176", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6598.66, "maximum": 9238.06, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9238.06, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6598.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULMONARY STRESS TESTING", "code_information": [{"code": "94618", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULSAVAC PLUS FAN KIT 00515047500", "code_information": [{"code": "515047500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 394.35, "discounted_cash": 236.61, "setting": "both", "billing_class": "facility"}]}, {"description": "PULSE GENERATOR IMPLANTABLE INSPIRE SLP APNEA", "code_information": [{"code": "L8679", "type": "HCPCS"}, {"code": "3024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 32240.0, "discounted_cash": 19344.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PULSE HIP PIN AND REGISTRATION 15CM 5050315", "code_information": [{"code": "5050315", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1209.6, "discounted_cash": 725.76, "setting": "both", "billing_class": "facility"}]}, {"description": "PULSE HIP PIN AND REGISTRATION FIDUCIAL 10CM 5050310", "code_information": [{"code": "5050310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1209.6, "discounted_cash": 725.76, "setting": "both", "billing_class": "facility"}]}, {"description": "PULSE KIT EMG  50120201", "code_information": [{"code": "50120201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1998.0, "discounted_cash": 1198.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PUMP PAIN 100 ML X 1 ML PER HR SOAKER", "code_information": [{"code": "PM036-A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 341.89, "discounted_cash": 205.13, "setting": "both", "billing_class": "facility"}]}, {"description": "PUMP PAIN 2-14 ML/HR 400 ML BLACK VAR RATE W/ SELECT A FLOW ONQ C BLOC", "code_information": [{"code": "CB004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 218.04, "discounted_cash": 130.82, "setting": "both", "billing_class": "facility"}]}, {"description": "PUMP PAIN 270 ML 4 ML/HR DUAL ONQ SILVERSOAKER", "code_information": [{"code": "PM015-A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 449.04, "discounted_cash": 269.42, "setting": "both", "billing_class": "facility"}]}, {"description": "PUMPINFUSION ON Q C BLOC 100 ML X 2 ML PER HOUR W/ SELECT A FLOW CATH", "code_information": [{"code": "PM012-A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 292.62, "discounted_cash": 175.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH 6279012 PSR TREPHINE INNER 6279012", "code_information": [{"code": "6279012", "type": "CDM"}], "standard_charges": [{"gross_charge": 468.75, "discounted_cash": 281.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH 6972426 RAIL 6972426", "code_information": [{"code": "6972426", "type": "CDM"}], "standard_charges": [{"gross_charge": 778.13, "discounted_cash": 466.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH 6972446 RAIL 6972446", "code_information": [{"code": "6972446", "type": "CDM"}], "standard_charges": [{"gross_charge": 778.13, "discounted_cash": 466.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH 6972447 RAIL 6972447", "code_information": [{"code": "6972447", "type": "CDM"}], "standard_charges": [{"gross_charge": 778.13, "discounted_cash": 466.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH 6972466 RAIL 6972466", "code_information": [{"code": "6972466", "type": "CDM"}], "standard_charges": [{"gross_charge": 778.13, "discounted_cash": 466.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH 6972467 RAIL 6972467", "code_information": [{"code": "6972467", "type": "CDM"}], "standard_charges": [{"gross_charge": 778.13, "discounted_cash": 466.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH 6972486 RAIL 6972486", "code_information": [{"code": "6972486", "type": "CDM"}], "standard_charges": [{"gross_charge": 778.13, "discounted_cash": 466.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH 6972487 RAIL 6972487", "code_information": [{"code": "6972487", "type": "CDM"}], "standard_charges": [{"gross_charge": 778.13, "discounted_cash": 466.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH APOLLO DISP", "code_information": [{"code": "-45P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 331.8, "discounted_cash": 199.08, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH BIOPSY 3MM SINGEL USE LF SSINSTR DISP", "code_information": [{"code": "33-32", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.23, "discounted_cash": 6.14, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH BX SKIN EA SEP/ADDL", "code_information": [{"code": "11105", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUNCH BX SKIN SINGLE LESION", "code_information": [{"code": "11104", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": 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775.42, "discounted_cash": 465.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PUSHER KNOT CUTTER SLOTTED CANNULA STRAIGHT FAST-FIX 360", "code_information": [{"code": "72202674", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.94, "discounted_cash": 240.56, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY  OSSIFUSE FLOWABLE FIBER BONE GRAFT 5CC 8263.0305S", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8263.0305S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY 10CC BIO4 VIABLE BONE MATRIX 3102-2110", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3102-2110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", 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[{"gross_charge": 2520.0, "discounted_cash": 1512.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY OSTEOFLO SYNTHETIC HYDRO HFP - 6CC OHFP-S-06", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OHFP-S-06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2772.0, "discounted_cash": 1663.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY OSTEOFLO SYNTHETIC HYDRO HFP 3CC OHFP-S-03", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OHFP-S-03", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1440.0, "discounted_cash": 864.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY OSTEOFUSE BIOACTIVE BONE GRAFT - 15.0G GBOF003", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "GBOF003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5577.0, "discounted_cash": 3346.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY OSTEOFUSE BIOACTIVE BONE GRAFT 15.0G", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "SGF-150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4368.0, "discounted_cash": 2620.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY OSTEOFUSE BIOACTIVE BONE GRAFT 3.75G", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "SGF-037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1260.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY OSTEOFUSE BIOACTIVE BONE GRAFT 7.50G", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "SGF-075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2497.6, "discounted_cash": 1498.56, "setting": "both", "billing_class": 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"code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "56300050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2457.0, "discounted_cash": 1474.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY PATENTED ABM+DBM+RPM CARRIER  PUTTY 56300100", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "56300100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4140.5, "discounted_cash": 2484.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY PATENTED ABM+DBM+RPM CARRIER+CANCELLOUS  PUTTY 56510050", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "56510050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3110.02, "discounted_cash": 1866.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY PROPEL  LARGE 5020010", "code_information": [{"code": "C1762", "type": 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[{"gross_charge": 4366.1, "discounted_cash": 2619.66, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTYINJECTABLE 2 ML ACCELSHIELD", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "ACI-5200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5374.79, "discounted_cash": 3224.87, "setting": "both", "billing_class": "facility"}]}, {"description": "PVB THORACIC 2ND+ INJ SITE", "code_information": [{"code": "64462", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PVB THORACIC SINGLE INJ SITE", "code_information": [{"code": "64461", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 919.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 684.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUAN MR TISS W/MRI MLT ORGN", "code_information": [{"code": "698T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 4173.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "QUAN MRI ALYS BRN W/DX MRI", "code_information": [{"code": "866T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding 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"code_information": [{"code": "3.808.003", "type": "CDM"}], "standard_charges": [{"gross_charge": 5594.4, "discounted_cash": 3356.64, "setting": "both", "billing_class": "facility"}]}, {"description": "QUICK RELEASE T-HANDLE 394.951", "code_information": [{"code": "394.951", "type": "CDM"}], "standard_charges": [{"gross_charge": 3730.32, "discounted_cash": 2238.19, "setting": "both", "billing_class": "facility"}]}, {"description": "QUICK-COMBO ELECTRODE ADULT 11996-000090", "code_information": [{"code": "11996-000090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 108.12, "discounted_cash": 64.87, "setting": "both", "billing_class": "facility"}]}, {"description": "QUIK USE FEMORAL BONE CEMENT PREP KIT POLY W/ BARIUM SULFATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "-5049-055-00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 945.0, "discounted_cash": 567.0, "setting": "both", "billing_class": "facility"}]}, {"description": "QUILL SUTURE 2-0", "code_information": [{"code": "RA-1002Q", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.76, "discounted_cash": 30.46, "setting": "both", "billing_class": "facility"}]}, {"description": "Quantiferon-TB Gold", "code_information": [{"code": "86480", "type": "CPT"}, {"code": "42888530", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "gross_charge": 152.0, "discounted_cash": 91.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 203.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 203.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 213.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 192.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 143.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 181.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 154.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R CR CEMENTED FEMORAL COMPONENT SZ 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1201-212-200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2785.63, "discounted_cash": 1671.38, "setting": "both", "billing_class": "facility"}]}, {"description": "R HRT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7521", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R HRT ART/GRFT ANG HRT FLOW", "code_information": [{"code": "C7552", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14607.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 11708.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11123.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10537.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 9952.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R HRT CATH CHD ABNL NT CNJ", "code_information": [{"code": "93594", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R HRT CATH CHD NML NT CNJ", "code_information": [{"code": "93593", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R HRT CORONARY ARTERY ANGIO", "code_information": [{"code": "93456", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 15456.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14607.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 11708.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11123.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10537.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 9952.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&I HRT ART/VENT ANG DRG AD", "code_information": [{"code": "C7553", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&L HRT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7527", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&L HRT ANGIO W/FLOW RESRV", "code_information": [{"code": "C7528", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&L HRT ART/VENTRICLE ANGIO", "code_information": [{"code": "93460", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 15456.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14607.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 11708.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11123.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10537.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 9952.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&L HRT ART/VENTRICLE ANGIO", "code_information": [{"code": "93461", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 15456.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14607.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 11708.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11123.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10537.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 9952.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&L HRT CATH CHD ABNL NT CNJ", "code_information": [{"code": "93597", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&L HRT CATH CHD NML NT CNJ", "code_information": [{"code": "93596", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&L HRT CATH W/VENTRICLGRPHY", "code_information": [{"code": "93453", "type": "CPT"}], "standard_charges": [{"minimum": 3574.0, "maximum": 15456.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14607.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 11708.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11123.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10537.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 9952.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R&L HRT GFT ANG W/FLOW RESRV", "code_information": [{"code": "C7529", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R-T PRS SENSING EDRL GDN SYS", "code_information": [{"code": "777T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 4173.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R-T SPCTRL ALYS PRST8 TISS", "code_information": [{"code": "443T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R3 CONST 58MM 71339158", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71339158", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6799.0, "discounted_cash": 4079.4, "setting": "both", "billing_class": "facility"}]}, {"description": "RABIES IG HEAT TREATED", "code_information": [{"code": "90376", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG HT&SOL HUMAN IM/SC", "code_information": [{"code": "90377", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES VACCINE ID", "code_information": [{"code": "90676", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RACHETTING T HANDLE SB090009", "code_information": [{"code": "SB090009", "type": "CDM"}], "standard_charges": [{"gross_charge": 2410.56, "discounted_cash": 1446.34, "setting": "both", "billing_class": "facility"}]}, {"description": "RAD OSTEO BLADE SZ 10 71369310", "code_information": [{"code": "71369310", "type": "CDM"}], "standard_charges": [{"gross_charge": 320.74, "discounted_cash": 192.44, "setting": "both", "billing_class": "facility"}]}, {"description": "RAD OSTEO BLADE SZ 12 71369312", "code_information": [{"code": "71369312", "type": "CDM"}], "standard_charges": [{"gross_charge": 320.74, "discounted_cash": 192.44, "setting": "both", "billing_class": "facility"}]}, {"description": "RAD OSTEO BLADE SZ 14 71369314", "code_information": [{"code": "71369314", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.74, "discounted_cash": 192.44, "setting": "both", "billing_class": "facility"}]}, {"description": "RAD OSTEO BLADE SZ 16 71369316", "code_information": [{"code": "71369316", "type": "CDM"}], "standard_charges": [{"gross_charge": 320.74, "discounted_cash": 192.44, "setting": "both", "billing_class": "facility"}]}, {"description": "RAD RESCJ TUM TISS A/E 5 CM+", "code_information": [{"code": "24079", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD ROD TI HEX 5.5MM X 80MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "482806080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3364.74, "discounted_cash": 2018.84, "setting": "both", "billing_class": "facility"}]}, {"description": "RADIAL KERATOTOMY 65771", "code_information": [{"code": "65771", "type": "CPT"}, {"code": "1481665", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIAL OSTEOTOME 16MM X 5IN 270904015", "code_information": [{"code": "270904015", "type": "CDM"}], "standard_charges": [{"gross_charge": 362.07, "discounted_cash": 217.24, "setting": "both", "billing_class": 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"BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIALUNCENT WIRE HOLDER 639.007", "code_information": [{"code": "639.007", "type": "CDM"}], "standard_charges": [{"gross_charge": 2350.08, "discounted_cash": 1410.05, "setting": "both", "billing_class": "facility"}]}, {"description": "RADIATION HANDLING", "code_information": [{"code": "77790", "type": "CPT"}], "standard_charges": [{"minimum": 193.18, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 193.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 273.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION PHYSICS CONSULT", "code_information": [{"code": "77336", "type": "CPT"}], "standard_charges": [{"minimum": 273.35, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 549.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 577.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 520.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 387.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 583.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 496.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION PHYSICS CONSULT", "code_information": [{"code": "77370", "type": "CPT"}], "standard_charges": [{"minimum": 441.8, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 441.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 887.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 887.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 934.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 840.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 625.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 583.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 496.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY DOSE PLAN", "code_information": [{"code": "77300", "type": "CPT"}], "standard_charges": [{"minimum": 171.96, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 171.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 345.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 345.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 363.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 327.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 243.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 583.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 496.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY MANAGEMENT", "code_information": [{"code": "77431", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY PLANNING", "code_information": [{"code": "77261", "type": "CPT"}], "standard_charges": [{"minimum": 82.38, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 82.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 165.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 165.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 174.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 156.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 116.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY PLANNING", "code_information": [{"code": "77262", "type": "CPT"}], "standard_charges": [{"minimum": 161.28, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 161.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 323.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 323.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 340.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 306.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 228.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY PLANNING", "code_information": [{"code": "77263", "type": "CPT"}], "standard_charges": [{"minimum": 221.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 443.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 443.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 467.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 420.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 313.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT AID(S)", "code_information": [{"code": "77332", "type": "CPT"}], "standard_charges": [{"minimum": 95.37, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 95.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 191.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 191.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 201.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 181.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 135.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 583.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 496.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT AID(S)", "code_information": [{"code": "77333", "type": "CPT"}], "standard_charges": [{"minimum": 387.52, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 387.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 778.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 778.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 819.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 737.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 548.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 583.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 496.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT AID(S)", "code_information": [{"code": "77334", "type": "CPT"}], "standard_charges": [{"minimum": 645.08, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 645.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1295.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1295.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1363.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1227.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 913.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1570.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1334.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77401", "type": "CPT"}], "standard_charges": [{"minimum": 65.64, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 65.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 131.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 131.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 138.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 124.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 92.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 535.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 455.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77402", "type": "CPT"}], "standard_charges": [{"minimum": 153.41, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 153.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 308.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 308.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 324.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 291.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 217.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 535.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 455.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77407", "type": "CPT"}], "standard_charges": [{"minimum": 238.76, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 238.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 479.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 479.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 504.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 454.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 338.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1150.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 978.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77412", "type": "CPT"}], "standard_charges": [{"minimum": 380.23, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 380.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 763.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 763.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 803.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 723.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 538.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1150.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 978.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TX MANAGEMENT X5", "code_information": [{"code": "77427", "type": "CPT"}], "standard_charges": [{"minimum": 270.3, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 270.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 542.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 542.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 571.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 514.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 382.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL ABDOMINAL HYSTERECTOMY W/ TOTAL PELVIC LYMPHADENECTOMY 58210", "code_information": [{"code": "58210", "type": "CPT"}, {"code": "1481667", 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PROXIMAL HEADLESS 3.0MM", "code_information": [{"code": "CD-FX-2530", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 755.44, "discounted_cash": 453.26, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER PROXIMAL POST  CD-IL-2065", "code_information": [{"code": "CD-IL-2065", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 518.7, "discounted_cash": 311.22, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER RETROGRADE 4.5 X 9.0MM 234-109-090", "code_information": [{"code": "234-109-090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 829.52, "discounted_cash": 497.71, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER RETROGRADE 4.5 X 9.5MM 0234109095", "code_information": [{"code": "234109095", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 837.9, "discounted_cash": 502.74, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER RIGID 11.5MM 2351-6112", "code_information": [{"code": "2351-6112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 603.63, "discounted_cash": 362.18, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SCREW  FOR CLICKX  PEDICLE SCREWS 388.355", "code_information": [{"code": "388.355", "type": "CDM"}], "standard_charges": [{"gross_charge": 1334.88, "discounted_cash": 800.93, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SCREW  FOR MATRIX BONE SCREWS 03.632.046", "code_information": [{"code": "3.632.046", "type": "CDM"}], "standard_charges": [{"gross_charge": 1143.8, "discounted_cash": 686.28, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SCREW 4MM CROSS IMP", "code_information": [{"code": "XFR006100-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1251.74, "discounted_cash": 751.04, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SCREW VILEX SMALL", "code_information": [{"code": "OS-VSLR1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 465.5, "discounted_cash": 279.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SHAFT BIXCUT FEMORAL TRINKLE 8.0 X 510MM", "code_information": [{"code": "227-8510S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1517.46, "discounted_cash": 910.48, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SLOTTED JUGGERLOC 6MM", "code_information": [{"code": "110010371", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 758.1, "discounted_cash": 454.86, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SLOTTED JUGGERLOC 7MM", "code_information": [{"code": "110010372", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 758.1, "discounted_cash": 454.86, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SLOTTED JUGGERLOC 8MM", "code_information": [{"code": "110010373", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 758.1, "discounted_cash": 454.86, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER STEM MTP FUSION CONE  16MM    CHARLOTTE  F and A SYSTEM 41112007", "code_information": [{"code": "41112007", "type": "CDM"}], "standard_charges": [{"gross_charge": 1231.2, "discounted_cash": 738.72, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER STEM MTP FUSION CONE  18MM    CHARLOTTE  F and A SYSTEM 41112008", "code_information": [{"code": "41112008", "type": "CDM"}], "standard_charges": [{"gross_charge": 1231.2, "discounted_cash": 738.72, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER STEM MTP FUSION CONE  20MM    CHARLOTTE  F and A SYSTEM 41112009", "code_information": [{"code": "41112009", "type": "CDM"}], "standard_charges": [{"gross_charge": 1231.2, "discounted_cash": 738.72, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER STEM MTP FUSION CONE  22MM    CHARLOTTE  F and A SYSTEM 41112010", "code_information": [{"code": "41112010", "type": "CDM"}], "standard_charges": [{"gross_charge": 1231.2, "discounted_cash": 738.72, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER STEM MTP FUSION CUP  18MM     CHARLOTTE  F and A SYSTEM 41112003", "code_information": [{"code": "41112003", "type": "CDM"}], "standard_charges": [{"gross_charge": 827.26, "discounted_cash": 496.36, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER STEM MTP FUSION CUP  20MM     CHARLOTTE  F and A SYSTEM 41112004", "code_information": [{"code": "41112004", "type": "CDM"}], "standard_charges": [{"gross_charge": 827.26, "discounted_cash": 496.36, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER STEM MTP FUSION CUP  22MM     CHARLOTTE  F and A SYSTEM 41112005", "code_information": [{"code": "41112005", "type": "CDM"}], "standard_charges": [{"gross_charge": 827.26, "discounted_cash": 496.36, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURFACING 16MM CONVEX", "code_information": [{"code": "XFR004216", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1814.4, "discounted_cash": 1088.64, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURFACING 18MM CONCAVE", "code_information": [{"code": "XFR004118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1814.4, "discounted_cash": 1088.64, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURFACING 18MM CONVEX", "code_information": [{"code": "XFR004218", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1124.93, "discounted_cash": 674.96, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURFACING 22MM CONVEXINSTR", "code_information": [{"code": "XFR004222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1814.4, "discounted_cash": 1088.64, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURFACING SIZE 14 SCREW CONVEX INSTRUMENT", "code_information": [{"code": "XFR004214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2352.0, "discounted_cash": 1411.2, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURG 22MM CONCAVE", "code_information": [{"code": "XFR004122", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1814.4, "discounted_cash": 1088.64, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURG 22MM METATARSAL", "code_information": [{"code": "AR-8944MR-22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1388.88, "discounted_cash": 833.33, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURG 6.5MM PILOT HEADED", "code_information": [{"code": "AR-1451", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 909.72, "discounted_cash": 545.83, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURG CONVEXINSTR 20MM", "code_information": [{"code": "XFR004220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1868.4, "discounted_cash": 1121.04, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER SURGACING INTRAMEDULLARY IMPLANT INSTR", "code_information": [{"code": "XFR001001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2864.75, "discounted_cash": 1718.85, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER TALAR  SIZE 1-3 33600123", "code_information": [{"code": "33600123", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 928.34, "discounted_cash": 557.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER TALAR  SIZE 4 AND 5 33600126", "code_information": [{"code": "33600126", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1016.12, "discounted_cash": 609.67, "setting": "both", "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35301", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35302", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35304", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35306", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35311", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35321", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35331", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35341", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee 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"CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35351", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35355", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35361", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35363", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": 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55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHARGER BELT LARGE FP9000L", "code_information": [{"code": "FP9000L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 208.0, "discounted_cash": 124.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RECIP BLADE DOUBLE SIDED STRYKER 71441570", "code_information": [{"code": "71441570", "type": "CDM"}], "standard_charges": [{"gross_charge": 199.08, "discounted_cash": 119.45, "setting": "both", "billing_class": "facility"}]}, {"description": "RECIPROCATING BLADE SINGLE SIDED HALL 71441574", "code_information": [{"code": "71441574", "type": "CDM"}], "standard_charges": [{"gross_charge": 203.82, "discounted_cash": 122.29, "setting": "both", "billing_class": "facility"}]}, {"description": "RECON, CTA FOR SURG PLAN", "code_information": [{"code": "G0288", "type": "HCPCS"}], "standard_charges": [{"minimum": 1005.45, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1005.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2019.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2019.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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MIDFACE OSTEOTOMIES AND BONE GRAFTS 21188 (IO)", "code_information": [{"code": "21188", "type": "CPT"}, {"code": "2025483", "type": "CDM"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14483.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECON. 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/GRAFT", "code_information": [{"code": "21194", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCATION OF ZYGOMATIC ARCH/GLENOID FOSSA 21255", "code_information": [{"code": "21255", "type": "CPT"}, {"code": "1481692", "type": "CDM"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT BRONCHUS", "code_information": [{"code": "31775", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT FOOT", "code_information": [{"code": "28360", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42205", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": 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"code_information": [{"code": "42210", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42215", "type": "CPT"}], "standard_charges": [{"minimum": 3869.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42225", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21182", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 9519.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21183", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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[{"code": "21184", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24361", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24362", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ENTIRE FOREHEAD", "code_information": [{"code": "21179", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ENTIRE FOREHEAD", "code_information": [{"code": "21180", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT EXTRA FINGER", "code_information": [{"code": "26587", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT HEAD OF RADIUS", "code_information": [{"code": "24365", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT INJURED CHEST", "code_information": [{"code": "32820", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LARYNX & PHARYNX", "code_information": [{"code": "31395", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LIP WITH FLAP", "code_information": [{"code": "40525", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LIP WITH FLAP", "code_information": [{"code": "40527", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ORBIT/FOREHEAD", 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"CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT VENA CAVA", "code_information": [{"code": "34502", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee 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"standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WINDPIPE", "code_information": [{"code": "31781", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF DISLOCATING PATELLA 27420", "code_information": [{"code": "27420", "type": "CPT"}, {"code": "1481711", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40842", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40843", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40845", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF PYLORUS", "code_information": [{"code": "43800", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 380.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 400.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 360.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 268.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED CELL MASS SINGLE", "code_information": [{"code": "78120", "type": "CPT"}], "standard_charges": [{"minimum": 174.78, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 174.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 351.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 351.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 369.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 332.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 247.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED CELL SEQUESTRATION", "code_information": [{"code": "78140", "type": "CPT"}], "standard_charges": [{"minimum": 270.92, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 270.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 544.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 544.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 572.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 515.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 383.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED CELL SURVIVAL STUDY", "code_information": [{"code": "78130", "type": "CPT"}], "standard_charges": [{"minimum": 285.9, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 285.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 574.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 574.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 604.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 544.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 404.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED DIST HOOK 12.0 179752012", "code_information": [{"code": "179752012", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RED DIST HOOK 5.0 179752015", "code_information": [{"code": "179752015", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RED DIST HOOK 6.5 179752016", "code_information": [{"code": "179752016", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RED DIST HOOK 8.0 179752018", "code_information": [{"code": "179752018", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RED TISSUE PAINT SL662RD-2", "code_information": [{"code": "SL662RD-2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 92.36, "discounted_cash": 55.42, "setting": "both", "billing_class": "facility"}]}, {"description": "REDO COMPL CARDIAC ANOMALY", "code_information": [{"code": "33622", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDO ENDOVAS VENA CAVA FILTR", "code_information": [{"code": "37192", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCE BOWEL OBSTRUCTION", "code_information": [{"code": "44050", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCED DISTANCE HOOK 179752010", "code_information": [{"code": "179752010", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REDUCED LAMINAR HOOK  LARGE 600-390", "code_information": [{"code": "600-390", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REDUCED LAMINAR HOOK  MEDIUM 600-375", "code_information": [{"code": "600-375", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REDUCED LAMINAR HOOK  SMALL 600-360", "code_information": [{"code": "600-360", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REDUCED TIP LAMINA HOOK LARGE 25-21-0609", "code_information": [{"code": "25-21-0609", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REDUCED TIP LAMINA HOOK MEDIUM 25-21-0607", "code_information": [{"code": "25-21-0607", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REDUCED TIP LAMINA HOOK-LG 10-21-0609", "code_information": [{"code": "10-21-0609", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REDUCED TIP LAMINA HOOK-MED 10-21-0607", "code_information": [{"code": 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[{"gross_charge": 494.76, "discounted_cash": 296.86, "setting": "both", "billing_class": "facility"}]}, {"description": "REDUCTION MAMMOPLASTY 19318", "code_information": [{"code": "19318", "type": "CPT"}, {"code": "1481737", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 14275.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF OVERCORRECTION OF PTOSIS 67909", "code_information": [{"code": "67909", "type": "CPT"}, {"code": "1700064", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case 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1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF SKULL DEFECT", "code_information": [{"code": "62115", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF SKULL DEFECT", "code_information": [{"code": "62117", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF TESTICULAR TORSION 54600", "code_information": [{"code": "54600", "type": "CPT"}, {"code": "1481741", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": 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2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OSTEOPLASTY-FACIAL BONES AUGMENTATION W/ GRAFT 21209", "code_information": [{"code": "21209", "type": "CPT"}, {"code": "1481738", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REFILL/MAINT PUMP/RESVR SYST", "code_information": [{"code": "96522", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REHABILITATION WITH CC/MCC", "code_information": [{"code": "945", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1246.0, "maximum": 10018.37, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1246.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1346.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1919.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2020.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1818.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1353.0, "methodology": "per diem"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 10018.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1387.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "REHABILITATION WITHOUT CC/MCC", "code_information": [{"code": "946", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1246.0, "maximum": 7653.42, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE 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1387.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "REIMPLANT ARTERY EACH", "code_information": [{"code": "35697", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50782", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50783", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50785", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANTATION OF KIDNEY", "code_information": [{"code": "50380", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE HIP BONES", "code_information": [{"code": "27187", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE PULMONARY ARTERY", "code_information": [{"code": "33690", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE RADIUS", "code_information": [{"code": "25490", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee 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"standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE RADIUS AND ULNA", "code_information": [{"code": "25492", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINNERVATE LARYNX", "code_information": [{"code": "31590", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINSERTION OCULAR IMPLANT W/FOREIGN MAT. 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINSERTION OF OCULAR IMPLANT W/WO CONJUNCTIVAL GRAFT 65150", "code_information": [{"code": "65150", "type": "CPT"}, {"code": "28481790", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINSERTION OF SPINAL FIXATION DEVICE 22849", "code_information": [{"code": "22849", "type": "CPT"}, {"code": "1481743", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 16185.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", 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"standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINSERTION RUPTURED BICEPS/TRICEPS TENDON-DISTAL W/ OR W/O GRAFT 24342", "code_information": [{"code": "24342", "type": "CPT"}, {"code": "1481744", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE INNER EAR CANAL", "code_information": [{"code": "69960", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE INTRINSIC MUSCLES HAND-EACH MUSCLE 26593", "code_information": [{"code": "26593", "type": "CPT"}, {"code": "1481749", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE MIDDLE EAR BONE", "code_information": [{"code": "69650", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF ENCIRCLING MATERIAL 67115", "code_information": [{"code": "67115", "type": "CPT"}, {"code": "33139028", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF EXTENSIVE SCAR TISSUE WITHOUT DETACHING EXTRAOCULAR MUSCLE 67343", "code_information": [{"code": "67343", "type": "CPT"}, {"code": "1481750", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8536.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF LUNG", "code_information": [{"code": "32220", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 9350.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SHOULDER LIGAMENT", "code_information": [{"code": "23415", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SKULL SEAMS", "code_information": [{"code": "61550", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SKULL SEAMS", "code_information": [{"code": "61552", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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"50940", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE TENDON ADDUCTOR HIP-OPEN 27001", "code_information": [{"code": "27001", "type": "CPT"}, {"code": "1481753", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO 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"case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE TENDON ADDUCTOR HIP-PERCUTANEOUS 27000", "code_information": [{"code": "27000", "type": "CPT"}, {"code": "1481752", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE TENDON ELBOW LATERAL OR MEDIAL-PERCUTANEOUS 24357", "code_information": [{"code": "24357", "type": "CPT"}, {"code": "1481754", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 10329.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"description": "RELEASE TENDON ELBOW W/DEBRIDEMENT-OPEN W/ TENDON REPAIR OR REATTACHMENT 24359", "code_information": [{"code": "24359", "type": "CPT"}, {"code": "1481756", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 10329.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", 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"both", "billing_class": "facility"}]}, {"description": "RELOAD GST BLUE 60MM 6ROW GST60B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GST60B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 316.8, "discounted_cash": 190.08, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD GST GREEN 60MM 6ROW GST60G", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GST60G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 261.0, "discounted_cash": 156.6, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD HERNIA 4 MM BLACK MULTIFIRE ENDO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "174015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 281.22, "discounted_cash": 168.73, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD LINEAR CUTTER -ORDR QTY 12 6R45B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6R45B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 286.0, "discounted_cash": 171.6, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD LINEAR CUTTER 75MM GREEN TRT75", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TRT75", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 98.04, "discounted_cash": 58.82, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD MULTIFIRE ENDO HERNIA 4.8 BLK 174007", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "174007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 281.22, "discounted_cash": 168.73, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD SIGNIA TRI-STAPLE BUTTRESS MED SIGTRSB60AMT", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "SIGTRSB60AMT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2448.1, "discounted_cash": 1468.86, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD STAPLE TRI 2.0 SUL TRS 60 ART MED THK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SIGTRS60AMT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2448.1, "discounted_cash": 1468.86, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD STAPLE TRO 2.0 SUL TRS 60 ART XTRA TH", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "SIGTRS60AXT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2448.1, "discounted_cash": 1468.86, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD STAPLER 2.5 MM RED GIA 60", "code_information": [{"code": "GIA6025S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 614.51, "discounted_cash": 368.71, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD STAPLER 2.5MM TO 3MM STAPLE VASCULAR PROXIMATE TI", "code_information": [{"code": "ESTRV30", "type": "CDM"}], "standard_charges": [{"gross_charge": 197.27, "discounted_cash": 118.36, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD STAPLER LINEAR TITANIUM 60MM BLUE XR60B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XR60B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 186.0, "discounted_cash": 111.6, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD STPLR 45MM GRN REG LINEAR CUTTER ENDO THKTIS PISTOL GRIP ENDOPATH LF STRL", "code_information": [{"code": "TR45G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 453.71, "discounted_cash": 272.23, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD STPLR 55MM BLUE LINEAR CUTTER SAFETY LOCKOUT PROXIMATE LF TI STRL", "code_information": [{"code": "TCR55", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.52, "discounted_cash": 54.91, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD SUREFORM 45 2.5 WHITE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48345W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3900.0, "discounted_cash": 2340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD SUREFORM 45 3.5 BLUE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48345B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 414.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD SUREFORM 60 2.5 WHITE DAVINCI X/XL", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "48360W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 336.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD SUREFORM 60 3.5 BLUE DAVINCI X/XL", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "48360B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 279.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD SUREFORM 60 4.3 GREEN DAVINCI  X/XI", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "48360G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 321.6, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD SUREFORM 60 4.6 BLACK DAVINIC  X/XI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48360T", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 414.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD TRI 2.0 SUL 60 ART XTRA THK SIG60AXT", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "SIG60AXT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1930.04, "discounted_cash": 1158.02, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOC SKIN POCKET PLS GEN", "code_information": [{"code": "416T", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELOCATE POCKET FOR DEFIB", "code_information": [{"code": "33223", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELOCATION OF TESTIS(ES)", "code_information": [{"code": "54680", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELOCATION POCKET PACEMAKER", "code_information": [{"code": "33222", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 9519.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM ANCHORAGE DEV W/O FLAP", "code_information": [{"code": "D7300", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 2566.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM ANCHORAGE DEVICE W/FLAP", "code_information": [{"code": "D7299", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 2566.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM ENDOVAS VENA CAVA FILTER", "code_information": [{"code": "37193", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV EVAL ICPMS", "code_information": [{"code": "93297", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV EVAL SCRMS", "code_information": [{"code": "93298", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG EVL PM/IDS", "code_information": [{"code": "93296", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG EVL PM/LDLS PM", "code_information": [{"code": "93294", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM MNTR PHYSIOL PARAM DEV", "code_information": [{"code": "99454", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM MNTR PHYSIOL PARAM SETUP", "code_information": [{"code": "99453", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM MNTR WRLS P-ART PRS SNR", "code_information": [{"code": "93264", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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"BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM PHYSIOL MNTR EA ADDL 20", "code_information": [{"code": "99458", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR 1ST 20 MIN", "code_information": [{"code": "98980", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR 1ST SETUP&EDU", "code_information": [{"code": "98975", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR DEV SPLY CBT", "code_information": [{"code": "98978", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR DEV SPLY RESP", "code_information": [{"code": "98976", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR DV SPLY MSCSKL", "code_information": [{"code": "98977", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR EA ADDL 20 MIN", "code_information": [{"code": "98981", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMICADE 100MG INJ", "code_information": [{"code": "MED0565", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1990.65, "discounted_cash": 1194.39, "setting": "both", "billing_class": "facility"}]}, {"description": "REMIFENTANIL 2MG IV INJ", "code_information": [{"code": "MED0505", "type": "CDM"}], "standard_charges": [{"gross_charge": 324.14, "discounted_cash": 194.48, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOBILIZATION TOOL FOR USS POLYAXIAL 03.603.108", "code_information": [{"code": "3.603.108", "type": "CDM"}], "standard_charges": [{"gross_charge": 9408.96, "discounted_cash": 5645.38, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOTE 30 DAY ECG REV/REPORT", "code_information": [{"code": "93228", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL AND REPLACEMENT OF INTERNALLY DWELLING URETERAL STENT VIA TRANSURETHRAL APPROACH 50385", "code_information": [{"code": "50385", "type": "CPT"}, {"code": "45384410", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL AND REPLACEMENT OF PENILE PROSTHESIS 54416", "code_information": [{"code": "54416", "type": "CPT"}, {"code": "1481762", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 23180.0, 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8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITHOUT GENERAL ANESTHESIA 69200", "code_information": [{"code": "69200", "type": "CPT"}, {"code": "1481772", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY GUM", "code_information": [{"code": "41805", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO 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"discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 10820.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 16760.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8850.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 14246.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16095.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 10988.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL IMPACTED CERUMEN W/INST. 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL NECK/ARMPIT LESION", "code_information": [{"code": "38550", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL NECK/ARMPIT LESION", "code_information": [{"code": "38555", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee 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"plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANKLE IMPLANT 27704", "code_information": [{"code": "27704", "type": "CPT"}, {"code": "1807652", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34001", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34051", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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"standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34101", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE 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"plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34151", "type": "CPT"}], "standard_charges": 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{"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34201", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER & NODES", "code_information": [{"code": "51585", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51520", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51530", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN ABSCESS", "code_information": [{"code": "61514", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN ABSCESS", "code_information": [{"code": "61522", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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"payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61518", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61520", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61521", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61524", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61526", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for 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"standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61530", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61534", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61537", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER 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"maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61539", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61540", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61566", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CERVIX RADICAL", "code_information": [{"code": "57531", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CHEST LINING", "code_information": [{"code": "32310", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 9350.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CLOT IN GRAFT", "code_information": [{"code": "35875", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE 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4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CLOT IN GRAFT", "code_information": [{"code": "35876", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON", "code_information": [{"code": "44150", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No 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"standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON/ILEOSTOMY", "code_information": [{"code": "44156", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COMPLETE CEREBROSPINAL FLUID SHUNT SYSTEM 62256", "code_information": [{"code": "62256", 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CORNEAL EPITHELIUM; WITH OR WITHOUT CHEMOCAUTERIZATION 65435", "code_information": [{"code": "65435", "type": "CPT"}, {"code": "17028704", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1060.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO 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2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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"standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EPITHELIAL DOWNGROWTH; ANTERIOR CHAMBER OF EYE 65900", "code_information": [{"code": "65900", "type": "CPT"}, {"code": "44781720", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 819.5, "maximum": 8427.0, "gross_charge": 1490.0, "discounted_cash": 894.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 819.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43107", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43113", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43124", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS POUCH", "code_information": [{"code": "43130", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS POUCH", "code_information": [{"code": "43135", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ETHMOID SINUS", "code_information": [{"code": "31201", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ETHMOID SINUS", "code_information": [{"code": "31205", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31087", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47610", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47612", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47620", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": 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"payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", "code_information": [{"code": "33542", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP PROSTHESIS", "code_information": [{"code": "27090", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP PROSTHESIS", "code_information": [{"code": "27091", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HUMERUS 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ISCHIAL BURSA", "code_information": [{"code": "27060", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY", "code_information": [{"code": "50340", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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"standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY & URETER", "code_information": [{"code": "50234", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY & URETER", "code_information": [{"code": "50236", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY LESION", "code_information": [{"code": "50280", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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"standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY LESION", "code_information": [{"code": "50290", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE CARTILAGE", "code_information": [{"code": "27332", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE CARTILAGE", "code_information": [{"code": "27333", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX", "code_information": [{"code": "31360", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee 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"plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX & PHARYNX", "code_information": [{"code": "31390", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX LESION", "code_information": [{"code": "31300", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEFT HEART VENT", "code_information": [{"code": "33989", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee 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"plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OCULAR IMPLANT 65175", "code_information": [{"code": "65175", "type": "CPT"}, {"code": "1481808", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PACEMAKER SYSTEM", "code_information": [{"code": "33234", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREATIC DUCT", "code_information": [{"code": "48148", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PM GENERATOR", "code_information": [{"code": "33233", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PROSTATE", "code_information": [{"code": "55801", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTAL MARKER", "code_information": [{"code": "46030", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45110", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45120", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RIB(S)", "code_information": [{"code": "32900", 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{"description": "REMOVAL OF SECONDARY MEMBRANOUS CATARACT; W/CORNEO-SACRAL SECTION; W/WO IRIDECTOMY 66830", "code_information": [{"code": "66830", "type": "CPT"}, {"code": "45422337", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SHUNT", "code_information": [{"code": "49429", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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AREA UP TO 15 LESIONS 11200", "code_information": [{"code": "11200", "type": "CPT"}, {"code": "4734926", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44121", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44125", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", 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PLATE/PADDLES VIA LAMINOTOMY/LAMINECTOMY INC. FLUORO. 63662", "code_information": [{"code": "63662", "type": "CPT"}, {"code": "2580939", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1487.75, "maximum": 8536.0, "gross_charge": 2705.0, "discounted_cash": 1623.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1487.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAYS-INC. 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"CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPINAL SHUNT", "code_information": [{"code": "63746", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", 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4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN PARTIAL", "code_information": [{"code": "38101", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee 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"CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN TOTAL", "code_information": [{"code": "38100", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN TOTAL", "code_information": [{"code": "38102", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43632", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43633", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43635", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SUBCUTANEOUS RESERVOIR OR PUMP 62365", "code_information": [{"code": "62365", "type": "CPT"}, {"code": "1481812", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8945.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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"plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SUBDELTOID CALCAREOUS DEPOSITS-OPEN 23000", "code_information": [{"code": "23000", "type": "CPT"}, {"code": "1481813", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SYNTHETIC ROD & INSERTION OF FLEXOR TENDON GRAFT HAND OR FINGER-EACH ROD 26392", "code_information": [{"code": "26392", "type": "CPT"}, {"code": "1481814", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TAIL BONE ULCER", "code_information": [{"code": "15922", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF UPPER JAW", "code_information": [{"code": "31230", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER 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8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA", "code_information": [{"code": "53210", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA", "code_information": [{"code": "53215", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA GLAND", "code_information": [{"code": "53250", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34421", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VITREOUS-ANTERIOR APPROACH-PARTIAL REMOVAL 67005", "code_information": [{"code": "67005", "type": "CPT"}, {"code": "1481816", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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{"description": "REMOVAL OF VITREOUS-ANTERIOR APPROACH-SUBTOTAL W/ MECHANICAL VITRECTOMY 67010", "code_information": [{"code": "67010", "type": "CPT"}, {"code": "1481815", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST PROSTHESIS", "code_information": [{"code": "25250", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, 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"plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST PROSTHESIS", "code_information": [{"code": "25251", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OR REPAIR OF ELECTROMAGNETIC BONE CONDUCTION HEARING DEVICE IN TEMPORAL BONE 69711", "code_information": [{"code": "69711", "type": "CPT"}, {"code": "1481817", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OR REVISION OF SLING FOR MALE URINARY INCONTINENCE 53442", "code_information": [{"code": "53442", "type": "CPT"}, {"code": "45897259", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "gross_charge": 5169.0, "discounted_cash": 3101.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 2842.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL/REVISION OF CAST", "code_information": [{"code": "29700", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL/REVISION OF CAST", "code_information": [{"code": "29705", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL/REVISION OF CAST", "code_information": [{"code": "29710", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE & TREAT BRAIN LESION", "code_information": [{"code": "61544", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ABDOMEN LYMPH NODES", "code_information": [{"code": "38780", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ABDOMINAL LYMPH NODES", "code_information": [{"code": "38747", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST 2 STAGE", "code_information": [{"code": "46285", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ANEURYSM SINUS", "code_information": [{"code": "61613", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33840", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33845", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33851", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"facility"}]}, {"description": "REMOVE AORTIC ASSIST DEVICE", "code_information": [{"code": "33968", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 37880.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 21883.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 37880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34092.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ARMPIT LYMPH NODES", "code_information": [{"code": "38740", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CANAL FLUID", "code_information": [{"code": "61050", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CAVITY FLUID", "code_information": [{"code": "61020", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN ELECTRODES", "code_information": [{"code": "61535", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN LINING LESION", "code_information": [{"code": "61512", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN LINING LESION", "code_information": [{"code": "61519", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN TUMOR W/SCOPE", "code_information": [{"code": "62164", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CADAVER DONOR KIDNEY", "code_information": [{"code": "50300", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CAROTID BODY LESION", "code_information": [{"code": "60600", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CAROTID BODY LESION", "code_information": [{"code": "60605", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CERCLAGE SUTURE", "code_information": [{"code": "59871", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX/REPAIR PELVIS", "code_information": [{"code": "57545", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLAR BONE LESION", "code_information": [{"code": "23170", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLOID CYST W/SCOPE", "code_information": [{"code": "62162", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CRANIAL CAVITY FLUID", "code_information": [{"code": "61000", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CRANIAL CAVITY FLUID", "code_information": [{"code": "61001", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CVA DEVICE OBSTRUCT", "code_information": [{"code": "75901", "type": "CPT"}], "standard_charges": [{"minimum": 898.77, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 898.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1805.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1805.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1900.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1710.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1273.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CVA LUMEN OBSTRUCT", "code_information": [{"code": "75902", "type": "CPT"}], "standard_charges": [{"minimum": 804.28, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 804.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1615.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1615.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1700.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1530.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1139.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE DRUG IMPLANT", "code_information": [{"code": "G0517", "type": "HCPCS"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELCTRD TRANSVENOUSLY", "code_information": [{"code": "33244", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33236", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33237", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33238", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELTRD/THORACOTOMY", "code_information": [{"code": "33243", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ESOPHAGUS OBSTRUCTION", "code_information": [{"code": "74235", "type": "CPT"}], "standard_charges": [{"minimum": 1182.15, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1182.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2374.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2374.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2499.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2249.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1674.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EXTRA SPINE SEGMENT", "code_information": [{"code": "22103", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EXTRA SPINE SEGMENT", "code_information": [{"code": "22116", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID FOREIGN BODY", "code_information": [{"code": "67938", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/FIXATION", "code_information": [{"code": "27358", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/GRAFT", "code_information": [{"code": "27357", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FINGER BONE", "code_information": [{"code": "26185", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREARM BONE LESION", "code_information": [{"code": "25145", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY ADBOMEN", "code_information": [{"code": "49402", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY BRAIN", "code_information": [{"code": "61570", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY LARYNX", "code_information": [{"code": "31511", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE GASTRIC PORT OPEN", "code_information": [{"code": "43887", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 16760.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 10820.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 16760.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8850.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 14246.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16095.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE GROIN LYMPH NODES", "code_information": [{"code": "38765", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP FOREIGN BODY", "code_information": [{"code": "27086", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15940", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15941", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15944", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15945", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HUMERUS LESION", "code_information": [{"code": "23174", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE IMPLANT BODY", "code_information": [{"code": "D6105", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 2566.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INFECTED SKULL BONE", "code_information": [{"code": "61501", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR LESION", "code_information": [{"code": "69970", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTERIM IMPLANT", "code_information": [{"code": "D6198", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 2566.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTESTINAL ALLOGRAFT", "code_information": [{"code": "44137", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRA-AORTIC BALLOON", "code_information": [{"code": "33974", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRACORPOREAL DEVICE", "code_information": [{"code": "33980", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRVAS FOREIGN BODY", "code_information": [{"code": "37197", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE JAW JOINT CARTILAGE", "code_information": [{"code": "21060", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE KIDNEY LIVING DONOR", "code_information": [{"code": "50320", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE KIDNEY OPEN", "code_information": [{"code": "50220", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE KNEE JOINT LINING", "code_information": [{"code": "27335", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUMB ARTIF DISC ADDL", "code_information": [{"code": "164T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG ARTERY EMBOLI", "code_information": [{"code": "33910", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG ARTERY EMBOLI", "code_information": [{"code": "33915", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG CATHETER", "code_information": [{"code": "32552", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG FOREIGN BODY", "code_information": [{"code": "32151", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG PNEUMONECTOMY", "code_information": [{"code": "32440", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE MASTOID AIR CELLS", "code_information": [{"code": "69670", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE MIDDLE EAR NERVE", "code_information": [{"code": "69676", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE NON-RESORB BARRIER", "code_information": [{"code": "D4286", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 2566.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PART OF NECK VERTEBRA", "code_information": [{"code": "22100", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PART THORAX VERTEBRA", "code_information": [{"code": "22101", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PELVIS LYMPH NODES", "code_information": [{"code": "38770", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PHARYNX FOREIGN BODY", "code_information": [{"code": "42809", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PITUIT TUMOR W/SCOPE", "code_information": [{"code": "62165", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PULMONARY SHUNT", "code_information": [{"code": "33924", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PULSE GENERATOR", "code_information": [{"code": "33241", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE RECTAL OBSTRUCTION", "code_information": [{"code": "45915", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE RECTUM W/RESERVOIR", "code_information": [{"code": "45119", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15931", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15933", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15934", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15935", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15936", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15937", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SCREW RETAINED PLATE", "code_information": [{"code": "D7298", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 2566.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER BLADE LESION", "code_information": [{"code": "23172", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER FB DEEP", "code_information": [{"code": "23333", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER JOINT LINING", "code_information": [{"code": "23105", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINAL CORD LESION", "code_information": [{"code": "63600", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE STENT VIA TRANSURETH", "code_information": [{"code": "50386", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15950", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15951", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", 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"standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15953", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15956", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee 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billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE TRANSPLANTED KIDNEY", "code_information": [{"code": "50370", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE URETER STENT PERCUT", "code_information": [{"code": "50384", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE UTERUS LESION", "code_information": [{"code": "59100", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA TISSUE COMPL", "code_information": [{"code": "57111", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VC LESION SCOPE/GRAFT", "code_information": [{"code": "31546", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VC LESION W/SCOPE", "code_information": [{"code": "31545", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTRICULAR DEVICE", "code_information": [{"code": "33977", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTRICULAR DEVICE", "code_information": [{"code": "33978", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN THRC", "code_information": [{"code": "63101", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63088", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63103", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63308", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE W INSERT DRUG IMPLANT", "code_information": [{"code": "G0518", "type": "HCPCS"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE WINDPIPE LESION", "code_information": [{"code": "31785", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE WINDPIPE LESION", "code_information": [{"code": "31786", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT HIP BONE LESION", "code_information": [{"code": "27067", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/INSERT DRUG IMPLANT", "code_information": [{"code": "11983", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/REPLACE INFLATABLE URETHRAL SPHINCTER W/PUMP RES. 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/TREAT LUNG LESIONS", "code_information": [{"code": "32141", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMV&REPLC PM GEN MULT LEADS", "code_information": [{"code": "33229", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENIN STIMULATION PANEL", "code_information": [{"code": "80416", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1080.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2170.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2170.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2284.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2056.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1530.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 612.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 520.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENIN STIMULATION PANEL", "code_information": [{"code": "80417", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 360.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 723.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 723.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 761.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 685.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 510.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REOPENING OF ABDOMEN", "code_information": [{"code": "49002", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 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SURG FOR ARTHROSCOPIC ACL OR PCL RECONSRUCTION STRL DISP", "code_information": [{"code": "AR-1802DR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.9, "discounted_cash": 32.94, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CANNULA THREADED 7.0MMX75MM 5PK CLEAR ST", "code_information": [{"code": "214116R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.82, "discounted_cash": 35.29, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CANNULA THREADED CLEAR WITH OBTURATOR ORANGE 5.5MM", "code_information": [{"code": "214108R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.82, "discounted_cash": 35.29, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CANNULAINSTR 5.75MM X 7 CM SMTH OPTIONAL 1-WAY STPCCK POLYCARBONATE W/ OBTURATOR", "code_information": [{"code": "AR-6562R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.56, "discounted_cash": 10.54, "setting": "both", "billing_class": "facility"}]}, {"description": "REP COMPRESSION GARMENT 18IN MD VASOPRESS DVT CALF", "code_information": [{"code": "VP 501MR", "type": "CDM"}], "standard_charges": [{"gross_charge": 54.08, "discounted_cash": 32.45, "setting": "both", "billing_class": "facility"}]}, {"description": "REP COMPRESSION GARMENT 24IN LG VASOPRESS DVT CALF", "code_information": [{"code": "VP 501LR", "type": "CDM"}], "standard_charges": [{"gross_charge": 54.08, "discounted_cash": 32.45, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF BLOOD PRESSURE 4 X 12IN AUTO SINGLE PORT-BLADDER", "code_information": [{"code": "60-7085-102R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.33, "discounted_cash": 32.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF BLOOD PRESSURE 4 X 12IN SINGLE PORT-BLADDER", "code_information": [{"code": "60-7075-102R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.33, "discounted_cash": 32.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF BLOOD PRESSURE DBL PORT SNLGBLADDER", "code_information": [{"code": "60-7070-107R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.15, "discounted_cash": 34.89, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF CALF VENAFLOW 19.0 X 11.5IN", "code_information": [{"code": "3010PLR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.09, "discounted_cash": 41.45, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF CALF VENAFLOW 19.0 X 11.5IN ELITE", "code_information": [{"code": "3040R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.42, "discounted_cash": 35.65, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF CALF VENAFLOW FOAM DUAL HOSE", "code_information": [{"code": "3030-PLR", "type": "CDM"}], "standard_charges": [{"gross_charge": 57.1, "discounted_cash": 34.26, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF FOOT VENAFLOW 16.0 X 9.0IN", "code_information": [{"code": "3016PLR", "type": "CDM"}], "standard_charges": [{"gross_charge": 56.76, "discounted_cash": 34.06, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF TOURNIQUET 18 X 4IN CYLINDRICAL COLOR SPSB", "code_information": [{"code": "5921-218-136R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.16, "discounted_cash": 34.9, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF TOURNIQUET 24 X 4IN CYLINDRICAL COLOR SPSB", "code_information": [{"code": "60-7075-104R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.15, "discounted_cash": 32.49, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF TOURNIQUET 30 X 4IN CYLINDRICAL COLOR SPSB", "code_information": [{"code": "5921-030-136R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.33, "discounted_cash": 32.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF TOURNIQUET 34IN 1 PORT 1 BLADDER PUMP LN CONN DISP", "code_information": [{"code": "60-7075-106R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.68, "discounted_cash": 36.41, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF TOURNIQUET 34IN AUTO SNGL BLADDER DUAL PORT", "code_information": [{"code": "60-7070-006R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.33, "discounted_cash": 32.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF TOURNIQUET 4 X 24IN SNGL BLADDER-PORT", "code_information": [{"code": "5921-024-136R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.33, "discounted_cash": 32.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF TOURNIQUET 4 X 42IN SNGL BLADDER-PORT", "code_information": [{"code": "60-7075-107R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.33, "discounted_cash": 32.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REP CUFF ZIMMER 18\"", "code_information": [{"code": "60-7075-103R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.15, "discounted_cash": 32.49, "setting": "both", "billing_class": "facility"}]}, {"description": "REP DEVICE CANNULA 5.5MM X 75MM ORANGE SMOOTH CLEAR", "code_information": [{"code": "214106R", "type": "CDM"}], "standard_charges": [{"gross_charge": 58.82, "discounted_cash": 35.29, "setting": "both", "billing_class": "facility"}]}, {"description": "REP DISK PROTECTIVE 7MM X 1IN BIOPATCH", "code_information": [{"code": "3152R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.57, "discounted_cash": 84.34, "setting": "both", "billing_class": "facility"}]}, {"description": "REP DRILL BIT FAST 2.0MM", "code_information": [{"code": "FDB2.0R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 365.35, "discounted_cash": 219.21, "setting": "both", "billing_class": "facility"}]}, {"description": "REP ELECTRODE HOOK 3.5MMINTEGRATED HANDPIECE VAPR", "code_information": [{"code": "227305R", "type": "CDM"}], "standard_charges": [{"gross_charge": 265.69, "discounted_cash": 159.41, "setting": "both", "billing_class": "facility"}]}, {"description": "REP EXPRESSEW III NEEDLE PK5", "code_information": [{"code": "214141R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 234.35, "discounted_cash": 140.61, "setting": "both", "billing_class": "facility"}]}, {"description": "REP FORCEP BX ENDOJAW ALLIGATOR JAW-STEP", "code_information": [{"code": "FB-220UR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.31, "discounted_cash": 39.79, "setting": "both", "billing_class": "facility"}]}, {"description": "REP GARMENT CALF LG", "code_information": [{"code": "DVT20R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.4, "discounted_cash": 33.84, "setting": "both", "billing_class": "facility"}]}, {"description": "REP GARMENT CALF VENAFLOW POS LOCK UP TO 19IN", "code_information": [{"code": "3010-PLR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.1, "discounted_cash": 34.26, "setting": "both", "billing_class": "facility"}]}, {"description": "REP GARMENT FOOT VENAFLOW POS LOCK UP TO 16IN", "code_information": [{"code": "3016-PLR", "type": "CDM"}], "standard_charges": [{"gross_charge": 73.94, "discounted_cash": 44.36, "setting": "both", "billing_class": "facility"}]}, {"description": "REP HOOK ELECTRODE 8.5ININSULATED ARTHROSCOPIC SS", "code_information": [{"code": "E1510R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.2, "discounted_cash": 57.12, "setting": "both", "billing_class": "facility"}]}, {"description": "REP INSTRUMENT CANNULA 5MM X 75MM FULLY THREADED ARTHROSCOPIC DRI LOK DISP", "code_information": [{"code": "3910-075-500R", "type": "CDM"}], "standard_charges": [{"gross_charge": 61.48, "discounted_cash": 36.89, "setting": "both", "billing_class": "facility"}]}, {"description": "REP INSTRUMENT CNULA 5.75MM X 7 CM OPTIONAL 1-WAY STPCCK POLYCARBONATE W/ OBTURATOR", "code_information": [{"code": "AR-6560R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.56, "discounted_cash": 10.54, "setting": "both", "billing_class": "facility"}]}, {"description": "REP KIT ENDO CTR 4MM SINGLE PORTAL", "code_information": [{"code": "9971R", "type": "CDM"}], "standard_charges": [{"gross_charge": 200.6, "discounted_cash": 120.36, "setting": "both", "billing_class": "facility"}]}, {"description": "REP KNIFE RETROGRADE LIGAMENT DISP", "code_information": [{"code": "200-1003R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.28, "discounted_cash": 252.17, "setting": "both", "billing_class": "facility"}]}, {"description": "REP KNIFE SAFEGUARD MINI", "code_information": [{"code": "8-0003R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 174.12, "discounted_cash": 104.47, "setting": "both", "billing_class": "facility"}]}, {"description": "REP MASK SURG PARTICULATE RESPIRATOR HYPOALLERGENIC TYPE N95 NIOSH APPROVED MOLDED F", "code_information": [{"code": "1860R", "type": "CDM"}], "standard_charges": [{"gross_charge": 28.4, "discounted_cash": 17.04, "setting": "both", "billing_class": "facility"}]}, {"description": "REP NDL DISSECTION 45 DEG 3/32IN MICRO COLORADO SLV", "code_information": [{"code": "N117R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.94, "discounted_cash": 52.16, "setting": "both", "billing_class": "facility"}]}, {"description": "REP NEEDLE INJ SUREFIRE FOR USEIN ARTHROSCOPIC AND MINI OPEN PROCEDURES SCORPIONINSTR", "code_information": [{"code": "AR-13991NR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 222.89, "discounted_cash": 133.73, "setting": "both", "billing_class": "facility"}]}, {"description": "REP NEEDLE INJECTION HUMPBACK MULTIFIRE SCORPIONINSTR DISP", "code_information": [{"code": "AR-13995NR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 243.54, "discounted_cash": 146.12, "setting": "both", "billing_class": "facility"}]}, {"description": "REP NEEDLE INJECTION SHOULDER SCORPION STRLINSTR", "code_information": [{"code": "AR-13990NR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 187.93, "discounted_cash": 112.76, "setting": "both", "billing_class": "facility"}]}, {"description": "REP NPH/URT CATH W/DIL STRIC", "code_information": [{"code": "C7546", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REP PERF ANOPER FISTU", "code_information": [{"code": "46715", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REP PERF ANOPER/VESTIB FISTU", "code_information": [{"code": "46716", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": 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ABD. HERNIA INITIAL INC. IMPLANT MESH;  3 CM TO 10 CM 49593", "code_information": [{"code": "49593", "type": "CPT"}, {"code": "46163783", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1362.9, "maximum": 10356.0, "gross_charge": 2478.0, "discounted_cash": 1486.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1362.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ANT. ABD. HERNIA INITIAL INC. MESH GREATER THAN 10 CM  INCARCERATED 49596", "code_information": [{"code": "49596", "type": "CPT"}, {"code": "46163788", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 10356.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ANT. ABD. HERNIA INITIAL INC. MESH LESS THAN 3 CM INCARCERATED 49592", "code_information": [{"code": "49592", "type": "CPT"}, {"code": "46163782", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 10356.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ANT. ABD. HERNIA INITIAL INCL. MESH;  3 CM TO 10 CM  INCARCERATED/STRANGULATED 49594", "code_information": [{"code": "49594", "type": "CPT"}, {"code": "46163784", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1362.9, "maximum": 10356.0, "gross_charge": 2478.0, "discounted_cash": 1486.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1362.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ANT. ABD. HERNIA RECURRENT INC. IMPLANT MESH LESS THAN 3 CM 49613", "code_information": [{"code": "49613", "type": "CPT"}, {"code": "46163789", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10356.0, "gross_charge": 18314.0, "discounted_cash": 10988.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 10072.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ANT. ABD. HERNIA RECURRENT INC. MESH 3 CM TO 10 CM 49615", "code_information": [{"code": "49615", "type": "CPT"}, {"code": "46163791", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10356.0, "gross_charge": 18314.0, "discounted_cash": 10988.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 10072.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ANT. ABD. HERNIA RECURRENT INC. MESH 3 CM TO 10 CM INCARCERATED 49616", "code_information": [{"code": "49616", "type": "CPT"}, {"code": "46163792", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10356.0, "gross_charge": 12070.0, "discounted_cash": 7242.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 6638.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ANT. ABD. HERNIA RECURRENT INC. MESH LESS THAN 3 CM INCARCERATED 49614", "code_information": [{"code": "49614", "type": "CPT"}, {"code": "46163790", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3070.0, "maximum": 10329.0, "gross_charge": 16171.0, "discounted_cash": 9702.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 8894.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ART INTRAMURAL", "code_information": [{"code": "33507", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERIAL TRUNK", "code_information": [{"code": "33786", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35082", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35092", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35103", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE ARM", "code_information": [{"code": "35013", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE BELLY", "code_information": [{"code": "35122", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE CHEST", "code_information": [{"code": "35022", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE GROIN", "code_information": [{"code": "35132", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE NECK", "code_information": [{"code": "35002", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE SPLEEN", "code_information": [{"code": "35112", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE THIGH", "code_information": [{"code": "35142", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY TRANSLOCATION", "code_information": [{"code": "33506", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY W/TUNNEL", "code_information": [{"code": "33505", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER & VAGINA", "code_information": [{"code": "57289", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER NECK", "code_information": [{"code": "51845", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35180", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35182", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35184", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35188", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee 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CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35189", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35190", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35211", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35216", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35221", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35226", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35231", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35236", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35241", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35246", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35261", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35266", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35271", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35276", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35281", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35286", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BRAIN FLUID LEAKAGE", "code_information": [{"code": "62100", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 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[{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BY ENLARGEMENT", "code_information": [{"code": "33610", "type": "CPT"}], "standard_charges": 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CARPAL BONE SHORTEN", "code_information": [{"code": "25394", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40700", "type": "CPT"}], "standard_charges": [{"minimum": 3869.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40701", "type": "CPT"}], "standard_charges": [{"minimum": 3869.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40702", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40761", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR CLITORIS", "code_information": [{"code": "56805", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR COLLATERAL LIGAMENT-MP OR IP JOINT 26540", "code_information": [{"code": "26540", "type": "CPT"}, {"code": "1481834", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR COMPLEX EYELID/NOSE/EAR/LIP EA ADD 5CM 13153", "code_information": [{"code": "13153", "type": "CPT"}, {"code": "1700134", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR COMPLEX FOREHEAD CHEEK CHIN MOUTH EA ADD 5CM 13133", "code_information": [{"code": "13133", "type": "CPT"}, {"code": "1643979", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35081", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35091", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35121", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DIAPHRAGM LACERATION", "code_information": [{"code": "39501", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee 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"standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DISLOCATED JAW", "code_information": [{"code": "21490", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DISLOCATING PERONEAL TENDONS; W/ FIBULAR OSTEOTOMY 27676", "code_information": [{"code": 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"standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DISLOCATING PERONEAL TENDONS; W/O FIBULAR OSTEOTOMY 27675", "code_information": [{"code": "27675", "type": "CPT"}, {"code": "1481992", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": 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4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DOUBLE VENTRICLE", "code_information": [{"code": "33612", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee 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"plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DURA", "code_information": [{"code": "61619", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EPISPADIAS 54380", "code_information": [{"code": "54380", "type": "CPT"}, {"code": "1481846", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EPISPADIAS DISTAL TO EXTERNAL SPHINCTER W/ INCONTINENCE 54385", "code_information": [{"code": "54385", "type": "CPT"}, {"code": "1481847", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS AND FISTULA", "code_information": [{"code": "43305", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS AND FISTULA", "code_information": [{"code": "43312", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS OPENING", "code_information": [{"code": "43420", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS OPENING", "code_information": [{"code": "43425", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET 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{"description": "REPAIR EXTENSOR TENDON HAND W/O FREE GRAFT-EACH TENDON 26410", "code_information": [{"code": "26410", "type": "CPT"}, {"code": "1481850", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": 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"standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EXTENSOR TENDON LEG SECONDARY W/ OR W/O GRAFT 27665", "code_information": [{"code": "27665", "type": "CPT"}, {"code": "1481856", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EXTRA TOE(S)", "code_information": [{"code": "28344", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", 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"standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR FACIAL NERVE", "code_information": [{"code": "69740", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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"plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33776", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for 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"standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33777", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33778", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33780", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33781", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GUM", "code_information": [{"code": "41872", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND DEFORMITY", "code_information": [{"code": "26580", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33641", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33681", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33684", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33688", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECTS", "code_information": [{"code": "33647", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 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"standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": 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"standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, 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"standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LAMINECTOMY DEFECT", "code_information": [{"code": "63295", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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"code_information": [{"code": "33220", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LEG FASCIA DEFECT", "code_information": [{"code": "27656", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47360", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47361", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47362", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LOWER LEG EPIPHYSES", "code_information": [{"code": "27734", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR LUMBAR HERNIA 49540", "code_information": [{"code": "49540", "type": "CPT"}, {"code": "11316972", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee 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[{"code": "32800", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR BLOOD VESSEL(S)", "code_information": [{"code": "33320", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR BLOOD VESSEL(S)", "code_information": [{"code": "33322", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR VESSEL", 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"standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NASAL SEPTAL PERFORATIONS 30630", "code_information": [{"code": "30630", "type": "CPT"}, {"code": "1700100", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8536.0, "gross_charge": 2156.0, 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 9593.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NASAL VALVE COLLAPSE W/SUBCUTANEOUS/SUBMUCOSAL LAT. WALL IMPLANT 30468", "code_information": [{"code": "30468", "type": "CPT"}, {"code": "45838027", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10329.0, "gross_charge": 17063.0, "discounted_cash": 10237.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 9384.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NASAL VESTIULAR STENOSIS NASAL WALL RECON 30465", "code_information": [{"code": "30465", "type": "CPT"}, {"code": "1643985", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 10329.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR NERVE ADD-ON", "code_information": [{"code": "64837", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLEPHAROPTOSIS; LEVATOR RESECTION OR ADVANCEMENT INTERNAL APPROACH 67903", "code_information": [{"code": "67903", "type": "CPT"}, {"code": "1481923", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EPISPADIAS WITH EXSTROPHY OF BLADDER 54390", "code_information": [{"code": "54390", "type": "CPT"}, {"code": "1481940", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ESOPHAGUS", "code_information": [{"code": "43300", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ESOPHAGUS", "code_information": [{"code": "43310", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EXTENSOR TENDON CENTRAL SLIP SECONDARY W/FREE GRAFT EA. FINGER 26428", "code_information": [{"code": "26428", "type": "CPT"}, {"code": "9033731", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65272", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FACIAL NERVE", "code_information": [{"code": "64864", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FACIAL NERVE", "code_information": [{"code": "64865", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FIBULA EPIPHYSIS", "code_information": [{"code": "27732", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FISTULA; ORONASAL 30600", "code_information": [{"code": "30600", "type": "CPT"}, {"code": "4327121", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "gross_charge": 6377.0, "discounted_cash": 3826.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 3507.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART CHAMBERS", "code_information": [{"code": "33670", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DAMAGE", "code_information": [{"code": "33545", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECT", "code_information": [{"code": "33720", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33660", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33665", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33694", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33697", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HYPOSPADIAS COMPLICATIONS-SIMPLE 54340", "code_information": [{"code": "54340", "type": "CPT"}, {"code": "1481944", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, 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OF UVEAL TISSUE 65285", "code_information": [{"code": "65285", "type": "CPT"}, {"code": "1481952", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 14275.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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843.15, "maximum": 14275.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LACERATION CONJUNCTIVA-DIRECT CLOSURE 65270", "code_information": [{"code": "65270", "type": "CPT"}, {"code": "1481955", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33427", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", 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"standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF NONUNION OR MALUNION TIBIA W/ILIAC OR OTHER AUTOGRAFT 27724", "code_information": [{"code": "27724", "type": "CPT"}, {"code": "5561471", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8945.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3330.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4892.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6688.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6336.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4717.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF STERNUM SEPARATION", "code_information": [{"code": "21750", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF STOMACH LESION", "code_information": [{"code": "43840", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SYMBLEPHARON; CONJUNCTIVOPLASTY WITHOUT GRAFT 68330", "code_information": [{"code": "68330", "type": "CPT"}, {"code": "1481969", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SYNDACTYLY EACH WEB SPACE W/SKIN FLAP 26560", "code_information": [{"code": "26560", "type": "CPT"}, {"code": "1941665", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TIBIA EPIPHYSIS", "code_information": [{"code": "27730", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TUNICA VAGINALIS HYDROCELE 55060", "code_information": [{"code": "55060", "type": "CPT"}, {"code": "1481970", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETER", "code_information": [{"code": "50900", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETER LESION", "code_information": [{"code": "51535", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA DEFECT", "code_information": [{"code": "53275", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA DEFECT", "code_information": [{"code": "53520", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53502", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53505", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53510", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53515", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRAL LESION", "code_information": [{"code": "57230", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF UTERUS", "code_information": [{"code": "59350", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31750", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31755", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31760", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE DEFECT", "code_information": [{"code": "31825", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE INJURY", "code_information": [{"code": "31800", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE INJURY", 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"plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PALATE", "code_information": [{"code": "42235", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PARAVAG DEFECT LAP", "code_information": [{"code": "57423", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PRIMARY TORN LIGAMENT AND/OR CAPSULE-KNEE; COLLATERAL 27405", "code_information": [{"code": "27405", "type": "CPT"}, {"code": "1481978", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PROFUNDUS TENDON W/ INTACT SUPERFICIALIS TENDON; PRIMARY EACH 26370", "code_information": [{"code": "26370", "type": "CPT"}, {"code": "1481979", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET 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4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PUL VENOUS STENOSIS", "code_information": [{"code": "33726", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee 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"CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PULMONARY ATRESIA", "code_information": [{"code": "33920", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33814", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33852", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33853", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SINGLE VENTRICLE", "code_information": [{"code": "33617", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SINGLE VENTRICLE", "code_information": [{"code": "33619", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SKULL CAVITY LESION", "code_information": [{"code": "62120", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SLEEP APNEA APPLIANCE", "code_information": [{"code": "D9949", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 2566.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR STERN/NUSS W/O SCOPE", "code_information": [{"code": "21742", "type": "CPT"}], "standard_charges": [{"minimum": 3574.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR STERNUM/NUSS W/SCOPE", "code_information": [{"code": "21743", "type": "CPT"}], "standard_charges": [{"minimum": 3574.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR STOMACH OPENING", "code_information": [{"code": "43870", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SYNDACTYLY EACH WEB SPACE W/ SKIN FLAPS/GRAFTS-COMPLEX 26562", "code_information": [{"code": "26562", "type": "CPT"}, {"code": "1481731", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET 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3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR THROAT ESOPHAGUS", "code_information": [{"code": "42953", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 9519.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TONGUE LACERATION", "code_information": [{"code": "41251", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR TUNNELED CV CATH", "code_information": [{"code": "36575", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VAGINA", "code_information": [{"code": "57335", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VALVE FEMORAL VEIN", "code_information": [{"code": "34501", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VENOUS ANOMALY", "code_information": [{"code": "33724", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL DEFECT", "code_information": [{"code": "33802", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL DEFECT", "code_information": [{"code": "33803", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL GRAFT DEFECT", "code_information": [{"code": "35870", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL-HAND/FINGER 35207", "code_information": [{"code": "35207", "type": "CPT"}, {"code": "1481997", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL-NECK 35201", "code_information": [{"code": "35201", "type": "CPT"}, {"code": "1482000", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 14275.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL-UPPER EXTREMITY 35206", "code_information": [{"code": "35206", "type": "CPT"}, {"code": "1482001", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 14275.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR WINDPIPE OPENING", "code_information": [{"code": "31613", "type": "CPT"}], "standard_charges": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR WOUND 2.5 CM OR LESS NECK/HANDS/FEET/EXTERNAL GENITALIA 12041", "code_information": [{"code": "12041", "type": "CPT"}, {"code": "1482002", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": 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"plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE DUOD/JEJ TUBE PERC", "code_information": [{"code": "49451", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE G-J TUBE PERC", "code_information": [{"code": "49452", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE G/C TUBE PERC", "code_information": [{"code": "49450", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE MATERIAL PROSTHESIS", "code_information": [{"code": "D6197", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 2566.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE PICVAD CATH", "code_information": [{"code": "36585", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE TRICUSPID VALVE", "code_information": [{"code": "33465", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36578", "type": "CPT"}], "standard_charges": [{"minimum": 3303.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36581", "type": "CPT"}], "standard_charges": [{"minimum": 3303.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": 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"standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36583", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE URETER BY BOWEL", "code_information": [{"code": "50840", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD INTRA W/BP", "code_information": [{"code": "33983", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD INTRA W/O BP", "code_information": [{"code": "33982", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD PUMP EXT", "code_information": [{"code": "33981", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE/IRRIGATE CATHETER", "code_information": [{"code": "62194", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE/IRRIGATE CATHETER", "code_information": [{"code": "62225", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33405", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33406", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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{"description": "REPLACEMENT/IRRIGATION OR REVISION  OF LUMBOSUBARACHNOID SHUNT 63744", "code_information": [{"code": "63744", "type": "CPT"}, {"code": "1482011", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT/REVISION CEREBROSPINAL FLUID SHUNT 62230", "code_information": [{"code": "62230", "type": "CPT"}, {"code": "1482010", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANT FOREARM COMPLETE", "code_information": [{"code": "20805", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION ARM COMPLETE", "code_information": [{"code": "20802", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION DIGIT COMPLETE", "code_information": [{"code": "20816", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION DIGIT COMPLETE", "code_information": [{"code": "20822", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION FOOT COMPLETE", "code_information": [{"code": "20838", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION HAND COMPLETE", "code_information": [{"code": "20808", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION OF PENIS", "code_information": [{"code": "54438", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION THUMB COMPLETE", "code_information": [{"code": "20824", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLANTATION THUMB COMPLETE", "code_information": [{"code": "20827", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOS CAR MODULJ TRANVNS ELT", "code_information": [{"code": "415T", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOS PREV IMPLTBL SUBQ DFB", "code_information": [{"code": "33273", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOS PREV SS IMPL DFB ELTRD", "code_information": [{"code": "574T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSG PERQ R/L HRT VAD", "code_information": [{"code": "33993", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSG PHRNC NRV STIM TRNSVN", "code_information": [{"code": "33281", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSITION GASTROSTOMY TUBE", "code_information": [{"code": "43761", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSITION L VENTRIC LEAD", "code_information": [{"code": "33226", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSITION PACING-DEFIB LEAD", "code_information": [{"code": "33215", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee 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CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSITION VENOUS CATHETER", "code_information": [{"code": "36597", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSITIONING OF INTRAOCULAR LENS PROSTHESIS-REQ. 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SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR OF ANAL FISTULA W/GLUE", "code_information": [{"code": "46706", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR PER/VAG POUCH DBL PROC", "code_information": [{"code": "46712", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee 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"plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPR PER/VAG POUCH SNGL PROC", "code_information": [{"code": "46710", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPRDTVE MED ALYS 24 CHRMSM", "code_information": [{"code": "254U", "type": "CPT"}], "standard_charges": [{"minimum": 1889.15, "maximum": 2222.68, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2222.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1889.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPROCESSED DISSECTOR 5MM CURVED", "code_information": [{"code": "5DCDR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 149.84, "discounted_cash": 89.9, "setting": "both", "billing_class": "facility"}]}, {"description": "REPROCESSED SAW BLADE 21X90X1.37MM", "code_information": [{"code": "6221-137-90R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.74, "discounted_cash": 46.64, "setting": "both", "billing_class": "facility"}]}, {"description": "REPROCESSED STRYKER SERFAS PROBE 90-S CRUISE 279401200RH", "code_information": [{"code": "279401200RH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 210.14, "discounted_cash": 126.08, "setting": "both", "billing_class": "facility"}]}, {"description": "REPROGRAM COCHLEAR IMPLT 7/>", "code_information": [{"code": "92604", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPROGRAM COCHLEAR IMPLT <7", "code_information": [{"code": "92602", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPTILASE TEST", "code_information": [{"code": "85635", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 79.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 159.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 159.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 167.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 150.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 112.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 28.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 24.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESCUEDRIVER 6.0MMHEX 647.66", "code_information": [{"code": "647.66", "type": "CDM"}], "standard_charges": [{"gross_charge": 1162.42, "discounted_cash": 697.45, "setting": "both", "billing_class": "facility"}]}, {"description": "RESECT APICAL LUNG TUM/CHEST", "code_information": [{"code": "32504", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT APICAL LUNG TUMOR", "code_information": [{"code": "32503", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT BACK TUM 5 CM/>", "code_information": [{"code": "21936", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT DIAPHRAGM COMPLEX", "code_information": [{"code": "39561", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT DISTAL FINGER TUMOR", "code_information": [{"code": "26262", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT ENLARGED TOE TISSUE", "code_information": [{"code": "28340", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FACE/SCALP TUM 2 CM/>", "code_information": [{"code": "21016", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FEMUR/KNEE TUMOR", "code_information": [{"code": "27365", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FIBULA TUMOR", "code_information": [{"code": "27646", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FOOT/TOE TUMOR < 3 CM", "code_information": [{"code": "28046", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FORARM/WRIST TUM 3CM>", "code_information": [{"code": "25078", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FOREARM/WRIST TUM<3CM", "code_information": [{"code": "25077", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HEART SAC LESION", "code_information": [{"code": "33050", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUM INCL ACETABUL", "code_information": [{"code": "27076", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUM W/INNOM BONE", "code_information": [{"code": "27077", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUMOR", "code_information": [{"code": "27075", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HIP/PELV TUM 5 CM/>", "code_information": [{"code": "27059", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT LEG/ANKLE TUM 5 CM/>", "code_information": [{"code": "27616", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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"standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT LEG/ANKLE TUM < 5 CM", "code_information": [{"code": "27615", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE 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"plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT METATARSAL TUMOR", "code_information": [{"code": "28173", "type": "CPT"}], "standard_charges": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT NASOPHARYNX SKULL", "code_information": [{"code": "61586", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee 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"plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT PHALANX OF TOE TUMOR", "code_information": [{"code": "28175", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT PROX HUMERUS TUMOR", "code_information": [{"code": "23220", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 9519.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT RADIUS/ULNAR TUMOR", "code_information": [{"code": "25170", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY 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"UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT RECUR GYN MAL W/LYM", "code_information": [{"code": "58958", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee 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[{"code": "58957", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT TALUS/CALCANEUS TUM", "code_information": [{"code": "27647", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT TARSAL TUMOR", "code_information": [{"code": "28171", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT TIBIA TUMOR", "code_information": [{"code": "27645", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT. INITIAL OVARIAN TUBAL-PRIMARY PERITO. 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OVARIAN -TUBAL-OR PRIMARY PERITONEAL MALIGNANCY W/ TAH & LYMPHADENECTOMY 58951", "code_information": [{"code": "58951", "type": "CPT"}, {"code": "1482016", "type": "CDM"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT. OVARIAN TUBAL -PRIMARY-PERITO. MALIG.W/ RADICAL DISSECTION FOR DEBULKING 58952", "code_information": [{"code": "58952", "type": "CPT"}, {"code": "1482019", "type": "CDM"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": 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"standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61600", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee 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"plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61601", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61605", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61606", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee 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"CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61607", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61608", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECTION FIRST CERVICAL  RIB W/SYMPATHECTOMY 21616", "code_information": [{"code": "21616", "type": "CPT"}, {"code": "1482029", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8945.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECTION FIRST/CERVICAL RIB 21615", "code_information": [{"code": "21615", "type": "CPT"}, {"code": "1482028", "type": "CDM"}, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1948.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1753.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1305.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 638.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 542.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIR IADNA 18 VIRAL&2 BACT", "code_information": [{"code": "115U", "type": "CPT"}], "standard_charges": [{"minimum": 685.31, "maximum": 806.3, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 806.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 685.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATOR MOTION MGMT SIMUL", "code_information": [{"code": "77293", "type": "CPT"}], "standard_charges": [{"minimum": 806.91, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1620.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1620.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1705.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1535.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1142.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1432.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1217.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY FLOW VOLUME LOOP", "code_information": [{"code": "94375", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee 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PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9354.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC", "code_information": [{"code": "177", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13511.47, "maximum": 18334.34, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 18334.34, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13511.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC", "code_information": [{"code": "179", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6763.81, "maximum": 8729.94, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 8729.94, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6763.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY NEOPLASMS WITH CC", "code_information": [{"code": "181", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8374.21, "maximum": 12593.02, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 12593.02, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8374.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY NEOPLASMS WITH MCC", "code_information": [{"code": "180", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12448.64, "maximum": 19823.55, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 19823.55, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12448.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY NEOPLASMS WITHOUT CC/MCC", "code_information": [{"code": "182", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5836.03, "maximum": 9498.93, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9498.93, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5836.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SENSING LEAD", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "4340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8775.0, "discounted_cash": 5265.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RESPIRATORY SIGNS AND SYMPTOMS", "code_information": [{"code": "204", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5634.18, "maximum": 9198.36, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9198.36, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5634.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SYNCYTIAL AG IF", "code_information": [{"code": "87280", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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{"description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS", "code_information": [{"code": "208", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17890.52, "maximum": 30439.66, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 30439.66, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 17890.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS", "code_information": [{"code": "207", "type": "MS-DRG"}], "standard_charges": [{"minimum": 41078.31, "maximum": 73350.98, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 73350.98, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESTORIS  Z 50MM ACETABULAR CUP 3400.50.000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3400.50.000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6362.2, "discounted_cash": 3817.32, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTRICTOR CEMENT 24MM", "code_information": [{"code": "EB0101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 909.72, "discounted_cash": 545.83, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTRICTOR CEMENT 25MM FEMORAL BUCK PLUG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "129419", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 909.72, "discounted_cash": 545.83, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTRICTOR CEMENT 8MM BIOSTOP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5463-08-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 422.58, "discounted_cash": 253.55, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTRICTOR CEMENT LG UNIVERSAL ORTHO", "code_information": [{"code": "5461-12-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 521.36, "discounted_cash": 312.82, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTRICTOR CEMENT MED UNIVERSAL W/ DISPOSABLEINSERTER OSTEONICS", "code_information": [{"code": "B000-1240", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 253.75, "discounted_cash": 152.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTRICTOR CEMENT POLYETHYLENE 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"type": "RC"}], "standard_charges": [{"gross_charge": 94.64, "discounted_cash": 56.78, "setting": "both", "billing_class": "facility"}]}, {"description": "RESUSCITATOR W MASK VITAL ADULT BLUE", "code_information": [{"code": "AE-6400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 102.43, "discounted_cash": 61.46, "setting": "both", "billing_class": "facility"}]}, {"description": "RETAINER NUT", "code_information": [{"code": "3.820.110.02S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 446.88, "discounted_cash": 268.13, "setting": "both", "billing_class": "facility"}]}, {"description": "RETIC", "code_information": [{"code": "85045", "type": "CPT"}, {"code": "1233836", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "gross_charge": 89.0, "discounted_cash": 53.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 222.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 57.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 48.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETROGRADE REAMER 4.5 X 9.0MM 0234109090", "code_information": [{"code": "234109090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 829.59, "discounted_cash": 497.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REUSABLE OBTURATOR FOR 7MM X 9CM CANNULA", "code_information": [{"code": "AR-6578-09", "type": "CDM"}, {"code": "272", "type": "RC"}], 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CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV LEAD", "code_information": [{"code": "270T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV TOTAL", "code_information": [{"code": "269T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV/RPLCMT SK-MNT CRNL NSTM", "code_information": [{"code": "61891", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC INTRA LITHOTRIP-ATHER", "code_information": [{"code": "C9766", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC INTRA LITHOTRIP-STENT", "code_information": [{"code": "C9765", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC INTRAVASC LITHOTRIPSY", "code_information": [{"code": "C9764", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC LITH-STEN-ATH TIB/PER", "code_information": [{"code": "C9775", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTR-ATHER TIB/PER", "code_information": [{"code": "C9774", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTR-STENT TIB/PER", "code_information": [{"code": "C9773", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTRIP TIBI/PERONE", "code_information": [{"code": "C9772", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTRIP-STENT-ATHER", "code_information": [{"code": "C9767", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASCULARIZATION PENIS", "code_information": [{"code": "37788", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVERE  4.5 ANGLED LAMINA HOOK  LARGE 1041.9957", "code_information": [{"code": "1041.9957", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  4.5 ANGLED LAMINA HOOK  MEDIUM 1041.9956", "code_information": [{"code": "1041.9956", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  4.5 ANGLED LAMINA HOOK  SMALL 1041.9955", "code_information": [{"code": "1041.9955", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  4.5 LAMINA HOOK  LARGE 1041.9946", "code_information": [{"code": "1041.9946", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  4.5 LAMINA HOOK  TALL BODY  LARGE 1041.9954", "code_information": [{"code": "1041.9954", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  4.5 LAMINA HOOK  TALL BODY  MEDIUM 1041.9953", "code_information": [{"code": "1041.9953", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  4.5 LAMINA HOOK  TALL BODY  SMALL 1041.9952", "code_information": [{"code": "1041.9952", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  4.5 LAMINA HOOK  WIDE  LARGE 1041.995", "code_information": [{"code": "1041.995", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  4.5 LAMINA HOOK  WIDE  MEDIUM 1041.9949", "code_information": [{"code": "1041.9949", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  4.5 LAMINA HOOK  WIDE  SMALL 1041.9948", "code_information": [{"code": "1041.9948", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  4.5 PEDICLE HOOK  SMALL 1041.9927", "code_information": [{"code": "1041.9927", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  4.5 THORACIC LAMINA HOOK  NARROW  SMALL 1041.9901", "code_information": [{"code": "1041.9901", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  4.5 TRANSVERSE PROCESS HOOK  LEFT 1041.9925", "code_information": [{"code": "1041.9925", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  4.5 TRANSVERSE PROCESS HOOK  RIGHT 1041.9924", "code_information": [{"code": "1041.9924", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 ANGLED LAMINA HOOK  LARGE 134.957", "code_information": [{"code": "134.957", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 ANGLED LAMINA HOOK  MEDIUM 134.956", "code_information": [{"code": "134.956", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 ANGLED LAMINA HOOK  SMALL 134.955", "code_information": [{"code": "134.955", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 LAMINA HOOK  LARGE  TRANSVERSE 134.933", "code_information": [{"code": "134.933", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 LAMINA HOOK  LARGE 134.946", "code_information": [{"code": "134.946", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 LAMINA HOOK  MEDIUM  TRANSVERSE 134.932", "code_information": [{"code": "134.932", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 LAMINA HOOK  MEDIUM 134.945", "code_information": [{"code": "134.945", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 LAMINA HOOK  NARROW  LARGE 134.942", "code_information": [{"code": "134.942", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 LAMINA HOOK  NARROW  MEDIUM 134.941", "code_information": [{"code": "134.941", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 LAMINA HOOK  NARROW  SMALL 134.94", "code_information": [{"code": "134.94", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 LAMINA HOOK  SMALL  TRANSVERSE 134.931", "code_information": [{"code": "134.931", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 LAMINA HOOK  SMALL 134.944", "code_information": [{"code": "134.944", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 LAMINA HOOK  TALL BODY  LARGE 134.954", "code_information": [{"code": "134.954", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 LAMINA HOOK  TALL BODY  MEDIUM 134.953", "code_information": [{"code": "134.953", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 LAMINA HOOK  TALL BODY  SMALL 134.952", "code_information": [{"code": "134.952", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 LAMINA HOOK  UPGOING  LARGE 134.908", "code_information": [{"code": "134.908", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 LAMINA HOOK  UPGOING  MEDIUM 134.907", "code_information": [{"code": "134.907", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 LAMINA HOOK  WIDE  LARGE 134.95", "code_information": [{"code": "134.95", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 LAMINA HOOK  WIDE  MEDIUM 134.949", "code_information": [{"code": "134.949", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 LAMINA HOOK  WIDE  SMALL 134.948", "code_information": [{"code": "134.948", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 OFFSET LAMINA HOOK  LEFT 134.922", "code_information": [{"code": "134.922", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 OFFSET LAMINA HOOK  RIGHT 134.921", "code_information": [{"code": "134.921", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 PEDICLE HOOK  LARGE  TRANSVERSE 134.937", "code_information": [{"code": "134.937", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 PEDICLE HOOK  LARGE 134.929", "code_information": [{"code": "134.929", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 PEDICLE HOOK  MEDIUM  TRANSVERSE 134.936", "code_information": [{"code": "134.936", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 PEDICLE HOOK  MEDIUM 134.928", "code_information": [{"code": "134.928", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 PEDICLE HOOK  SMALL  TRANSVERSE 134.935", "code_information": [{"code": "134.935", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 PEDICLE HOOK  SMALL 134.927", "code_information": [{"code": "134.927", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 THORACIC LAMINA HOOK  MEDIUM 134.905", "code_information": [{"code": "134.905", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 THORACIC LAMINA HOOK  NARROW  MEDIUM 134.902", "code_information": [{"code": "134.902", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 THORACIC LAMINA HOOK  NARROW  SMALL 134.901", "code_information": [{"code": "134.901", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 THORACIC LAMINA HOOK  SMALL 134.904", "code_information": [{"code": "134.904", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 TRANSVERSE PROCESS HOOK  LEFT 134.925", "code_information": [{"code": "134.925", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE  6.35 TRANSVERSE PROCESS HOOK  RIGHT 134.924", "code_information": [{"code": "134.924", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE 4.5 LAMINA HOOK  EXTRA OFFSET  LEFT 1041.9983", "code_information": [{"code": "1041.9983", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE 4.5 LAMINA HOOK  EXTRA OFFSET  RIGHT 1041.998", "code_information": [{"code": "1041.998", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE 4.5 LAMINA HOOK  MEDIUM 1041.9945", "code_information": [{"code": "1041.9945", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE 4.5 LAMINA HOOK  NARROW  LARGE 1041.9942", "code_information": [{"code": "1041.9942", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE 4.5 LAMINA HOOK  NARROW  MEDIUM 1041.9941", "code_information": [{"code": "1041.9941", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE 4.5 LAMINA HOOK  NARROW  SMALL 1041.994", "code_information": [{"code": "1041.994", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE 4.5 LAMINA HOOK  SMALL 1041.9944", "code_information": [{"code": "1041.9944", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE 4.5 LAMINA HOOK  UPGOING  LARGE 1041.9908", "code_information": [{"code": "1041.9908", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE 4.5 LAMINA HOOK  UPGOING  MEDIUM 1041.9907", "code_information": [{"code": "1041.9907", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE 4.5 PEDICLE HOOK  LARGE 1041.9929", "code_information": [{"code": "1041.9929", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE 4.5 PEDICLE HOOK  MEDIUM 1041.9928", "code_information": [{"code": "1041.9928", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE 4.5 THORACIC LAMINA HOOK  MEDIUM 1041.9905", "code_information": [{"code": "1041.9905", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE 4.5 THORACIC LAMINA HOOK  NARROW  MEDIUM 1041.9902", "code_information": [{"code": "1041.9902", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE 4.5 THORACIC LAMINA HOOK  SMALL 1041.9904", "code_information": [{"code": "1041.9904", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE OFFSET EXTENSION CLAMP, 5.5MM-6.0MM, 5.5MM ROD, RIGHT, 160MM LENGTH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "154.725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6453.2, "discounted_cash": 3871.92, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE OFFSET HOUSING CLAMP  15MM  25 and DEG UP 154.532", "code_information": [{"code": "154.532", "type": "CDM"}], "standard_charges": [{"gross_charge": 1231.58, "discounted_cash": 738.95, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE OFFSET HOUSING CLAMP  15MM  LEFT  25 and DEG UP 154.55", "code_information": [{"code": "154.55", "type": "CDM"}], "standard_charges": [{"gross_charge": 1231.58, "discounted_cash": 738.95, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE OFFSET HOUSING CLAMP  15MM  LEFT 154.51", "code_information": [{"code": "154.51", "type": "CDM"}], "standard_charges": [{"gross_charge": 1231.58, "discounted_cash": 738.95, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE OFFSET HOUSING CLAMP  15MM  RIGHT  25 and DEG UP 154.56", "code_information": [{"code": "154.56", "type": "CDM"}], "standard_charges": [{"gross_charge": 2062.8, "discounted_cash": 1237.68, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE OFFSET HOUSING CLAMP  15MM  RIGHT 154.52", "code_information": [{"code": "154.52", "type": "CDM"}], "standard_charges": [{"gross_charge": 1231.58, "discounted_cash": 738.95, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE OFFSET HOUSING CLAMP  20MM  25 and DEG UP 154.542", "code_information": [{"code": "154.542", "type": "CDM"}], "standard_charges": [{"gross_charge": 1231.58, "discounted_cash": 738.95, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE OFFSET HOUSING CLAMP  20MM  LEFT  25 and DEG UP 154.552", "code_information": [{"code": "154.552", "type": "CDM"}], "standard_charges": [{"gross_charge": 2062.8, "discounted_cash": 1237.68, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE OFFSET HOUSING CLAMP  20MM  LEFT 154.512", "code_information": [{"code": "154.512", "type": "CDM"}], "standard_charges": [{"gross_charge": 1231.58, "discounted_cash": 738.95, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE OFFSET HOUSING CLAMP  20MM  RIGHT  25 and DEG UP 154.562", "code_information": [{"code": "154.562", "type": "CDM"}], "standard_charges": [{"gross_charge": 2062.8, "discounted_cash": 1237.68, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE OFFSET HOUSING CLAMP  20MM  RIGHT 154.522", "code_information": [{"code": "154.522", "type": "CDM"}], "standard_charges": [{"gross_charge": 1231.58, "discounted_cash": 738.95, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE OFFSET HOUSING CLAMP  STRAIGHT  15MM 154.5", "code_information": [{"code": "154.5", "type": "CDM"}], "standard_charges": [{"gross_charge": 2062.8, "discounted_cash": 1237.68, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERE OFFSET HOUSING CLAMP  STRAIGHT  20MM 154.502", "code_information": [{"code": "154.502", "type": "CDM"}], "standard_charges": [{"gross_charge": 1231.58, "discounted_cash": 738.95, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERSE CURVED TIP RETRACTOR  12MM X 150MM 687.165", "code_information": [{"code": "687.165", "type": "CDM"}], "standard_charges": [{"gross_charge": 1900.8, "discounted_cash": 1140.48, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERSE CURVED TIP RETRACTOR  12MM X 200MM 687.166", "code_information": [{"code": "687.166", "type": "CDM"}], "standard_charges": [{"gross_charge": 1900.8, "discounted_cash": 1140.48, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERSE CURVED TIP RETRACTOR  8MM X 150MM 687.163", "code_information": [{"code": "687.163", "type": "CDM"}], "standard_charges": [{"gross_charge": 1900.8, "discounted_cash": 1140.48, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERSE CURVED TIP RETRACTOR  8MM X 200MM 687.164", "code_information": [{"code": "687.164", "type": "CDM"}], "standard_charges": [{"gross_charge": 1900.8, "discounted_cash": 1140.48, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERSED INSERT PERFORM HUMERAL SYSTEM DWP1366", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWP1366", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2700.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERSED TRAY CENTERED +12 DWF502", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3802.5, "discounted_cash": 2281.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERSED TRAY CENTERED +6 DWF501", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3802.5, "discounted_cash": 2281.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERSED TRAY LOW OFFSET + 12 DWF512", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4647.5, "discounted_cash": 2788.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REVIEW PATIENT SPIROMETRY", "code_information": [{"code": "94016", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE & REPAIR CHEST WALL", "code_information": [{"code": "32905", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE & REPAIR CHEST WALL", "code_information": [{"code": "32906", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE ABDOMEN-VENOUS SHUNT", "code_information": [{"code": "49426", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61705", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61708", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61710", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE CORNEA WITH IMPLANT", "code_information": [{"code": "65770", "type": "CPT"}], "standard_charges": [{"minimum": 3869.0, "maximum": 9350.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE W/SUTURE", "code_information": [{"code": "67334", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE(S) ADD-ON", "code_information": [{"code": "67320", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21260", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21261", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21263", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21267", "type": "CPT"}], "standard_charges": [{"minimum": 3869.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee 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CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID LINING", "code_information": [{"code": "68360", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee 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CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE GASTRIC PORT OPEN", "code_information": [{"code": "43886", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 16760.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 10820.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 16760.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8850.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 14246.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 16095.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE GRAFT W/VEIN", "code_information": [{"code": "35879", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE GRAFT W/VEIN", "code_information": [{"code": "35881", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE HEAD/NECK OF FEMUR", "code_information": [{"code": "27179", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE LEG VEIN", "code_information": [{"code": "37700", "type": "CPT"}], "standard_charges": [{"minimum": 3303.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE LOW BACK NERVE(S)", "code_information": [{"code": "64714", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE LOWER LEG TENDONS", "code_information": [{"code": "27686", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE LUMB ARTIF DISC ADDL", "code_information": [{"code": "165T", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33820", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 23180.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 13391.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 23180.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33822", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33824", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 23180.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 13391.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 23180.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE OCULAR IMPLANT", "code_information": [{"code": "65125", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 9519.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE OVARIAN TUBE(S)", "code_information": [{"code": "58752", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE PALSY HAND TENDON(S)", "code_information": [{"code": "25315", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE PALSY HAND TENDON(S)", "code_information": [{"code": "25316", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE PROSTH VAG GRAFT LAP", "code_information": [{"code": "57426", "type": "CPT"}], "standard_charges": [{"minimum": 3330.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3330.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4892.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6688.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6336.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4717.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE RECONST ELBOW JOINT", "code_information": [{"code": "24371", "type": "CPT"}], "standard_charges": [{"minimum": 3869.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE SPINAL CORD VSLS CRVL", "code_information": [{"code": "63250", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE SPINAL CORD VSLS THRC", "code_information": [{"code": "63251", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE SPINE CORD VSL THRLMB", "code_information": [{"code": "63252", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE SPINE ELTRD PERQ ARAY", "code_information": [{"code": "63663", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE STOMACH-BOWEL FUSION", "code_information": [{"code": "43860", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE STOMACH-BOWEL FUSION", "code_information": [{"code": "43865", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee 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[{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE THUMB TENDON", "code_information": [{"code": "26490", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE THUMB TENDON", "code_information": [{"code": "26496", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE URETER", "code_information": [{"code": "50727", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE URETER", "code_information": [{"code": "50728", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE URINE FLOW", "code_information": [{"code": "50830", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE VAG GRAFT OPEN ABD", "code_information": [{"code": "57296", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE VENTRICLE MUSCLE", "code_information": [{"code": "33416", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68335", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/REPL VAGUS N ELTRD", "code_information": [{"code": "64569", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee 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"type": "CPT"}, {"code": "1480220", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 14275.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION COLOSTOMY W/REPAIR PARACOLOSTOMY HERNIA 44346", "code_information": [{"code": "44346", "type": "CPT"}, {"code": "1482043", "type": "CDM"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION COLOSTOMY-COMPLICATED 44345", "code_information": [{"code": "44345", "type": "CPT"}, {"code": "1482044", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "59325", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37140", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37145", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37160", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37180", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65600", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65765", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF DIAPHRAGM", "code_information": [{"code": "39545", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF ELBOW JOINT", "code_information": [{"code": "24470", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "21280", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "21282", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33476", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33478", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33735", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33736", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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[{"code": "33737", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP BONE", "code_information": [{"code": "27147", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP BONES", "code_information": [{"code": "27156", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP OR KNEE REPLACEMENT WITH CC", "code_information": [{"code": "467", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17807.0, "maximum": 38848.62, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 38848.62, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 21770.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 34654.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 17807.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 29456.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 34953.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 33787.81, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 25433.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 24161.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 22890.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 21618.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP OR KNEE REPLACEMENT WITH MCC", "code_information": [{"code": "466", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17807.0, "maximum": 57782.95, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 57782.95, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 21770.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 34654.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 17807.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 29456.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 34953.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 49782.12, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 25433.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 24161.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 22890.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 21618.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC", "code_information": [{"code": "468", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17807.0, "maximum": 34953.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 29753.47, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 21770.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 34654.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 17807.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 29456.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA CHOICE CARE", "standard_charge_dollar": 34953.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 27177.07, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 25433.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 24161.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 22890.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 21618.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HORSESHOE KIDNEY", "code_information": [{"code": "50540", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HUMERUS", "code_information": [{"code": "24410", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF INFUSION PUMP", "code_information": [{"code": "36261", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF IRIS", "code_information": [{"code": "66762", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"facility"}]}, {"description": "REVISION OF JAW MUSCLE/BONE", "code_information": [{"code": "21295", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF JAW MUSCLE/BONE", "code_information": [{"code": "21296", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF KIDNEY/URETER", "code_information": [{"code": "50400", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27440", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27441", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27443", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27445", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF LARYNX", "code_information": [{"code": "31400", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF LEG VEIN", "code_information": [{"code": "37780", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF LUNG", "code_information": [{"code": "32940", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF MAJOR VEIN", "code_information": [{"code": "37650", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF MAJOR VEIN", "code_information": [{"code": "37660", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "33420", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "33422", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "92987", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21700", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21720", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21725", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE/RIB", "code_information": [{"code": "21705", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PELVIS", "code_information": [{"code": "27158", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54420", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PULMONARY VALVE", "code_information": [{"code": "33474", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": 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8427.0, "gross_charge": 1490.0, "discounted_cash": 894.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 819.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5480.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OFFSET STEM ADAPTOR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1513-04-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVISION OR REMOVAL OF CRANIAL NEUROSTIMULATOR PULSE GEN OR REC. 61888", "code_information": [{"code": "61888", "type": "CPT"}, {"code": "1891044", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATOR GENERATOR/RECEIVER 63688", "code_information": [{"code": "63688", "type": "CPT"}, {"code": "1482051", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "gross_charge": 5393.0, "discounted_cash": 3235.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 2966.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR ELECTRODE ARRAY 64585", "code_information": [{"code": "64585", "type": "CPT"}, {"code": "9909517", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OR REPLACEMENT HYPOGLOSSAL NERVE NEUROSTIM 64583", "code_information": [{"code": "64583", "type": "CPT"}, {"code": "46008052", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "gross_charge": 24722.0, "discounted_cash": 14833.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION POSTERIOR FEMORAL AUGMENT SIZE 4 4MM CENEMENTED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1549-04-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 990.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVISION SUBVALVULAR TISSUE", "code_information": [{"code": "33415", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION TIBIAL BASE ROTATING PLATFORM SIZE 4 CEMENTED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1506-60-004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5837.0, "discounted_cash": 3502.2, "setting": "both", "billing_class": "facility"}]}, {"description": "REVISION TIPS", "code_information": [{"code": "37183", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION TOTAL HIP ARTHROPLASTY ACETABULAR W/ OR W/O GRAFT 27137", "code_information": [{"code": "27137", "type": "CPT"}, {"code": "1807653", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2966.15, "maximum": 18989.0, "gross_charge": 5393.0, "discounted_cash": 3235.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ FEM ANAST AUTOG VN GRF", "code_information": [{"code": "35884", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ FEM ANAST NONAUTOG GRF", "code_information": [{"code": "35883", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ RPLCMT/RMVL VRT TETHRG", "code_information": [{"code": "790T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL INS PTN SUBF", "code_information": [{"code": "819T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL INS PTN SUBQ", "code_information": [{"code": "818T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA PN W/INT NSTIM", "code_information": [{"code": "64598", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA SAC W/NSTIM", "code_information": [{"code": "787T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA SPI W/NSTIM", "code_information": [{"code": "785T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVOLVE BONE ACCESS NEEDLE  11G  BEVEL TIP 685.031S", "code_information": [{"code": "685.031S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.48, "discounted_cash": 147.89, "setting": "both", "billing_class": "facility"}]}, {"description": "REVOLVE BONE ACCESS NEEDLE  11G  TROCAR TIP 685.030S", "code_information": [{"code": "685.030S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.48, "discounted_cash": 147.89, "setting": "both", "billing_class": "facility"}]}, {"description": "REVOLVE BONE ACCESS NEEDLE  8G  BEVEL TIP 685.028S", "code_information": [{"code": "685.028S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 189.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REVOLVE BONE ACCESS NEEDLE  8G  TROCAR TIP 685.027S", "code_information": [{"code": "685.027S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.48, "discounted_cash": 147.89, "setting": "both", "billing_class": "facility"}]}, {"description": "REVOLVE FAT PROCESSING SYSTEM RV0001", "code_information": [{"code": "RV0001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1213.92, "discounted_cash": 728.35, "setting": "both", "billing_class": "facility"}]}, {"description": "REVSC OPN/PRQ TIB/PERO STENT", "code_information": [{"code": "37234", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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{"description": "RH IG IV", "code_information": [{"code": "90386", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RH IG MINIDOSE IM", "code_information": [{"code": "90385", "type": 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"type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "gross_charge": 147.0, "discounted_cash": 88.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 31.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 64.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 64.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 67.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 60.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 45.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHD&RHCE GNTYP NEXT GNRJ SEQ", "code_information": [{"code": "222U", "type": "CPT"}], "standard_charges": [{"minimum": 704.04, "maximum": 828.33, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 828.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 704.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHD&RHCE GNTYP RHD1-10&RHCE5", "code_information": [{"code": "198U", "type": "CPT"}], "standard_charges": [{"minimum": 704.04, "maximum": 828.33, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 828.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 704.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHEUMATOID FACTOR TEST QUAL", "code_information": [{"code": "86430", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 87.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 87.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 92.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 82.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 61.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 17.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 15.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHINECTOMY TOTAL 30160", "code_information": [{"code": "30160", "type": "CPT"}, {"code": "3170910", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHINO/ELEPHANT EAR WASHER SINGLE-USE TIPS", "code_information": [{"code": "TI", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.67, "discounted_cash": 3.4, "setting": "both", "billing_class": "facility"}]}, {"description": "RHINOPLASTY COMPLETE 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTHM ECG TRACING", "code_information": [{"code": "93041", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for 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3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTHM ECG WITH REPORT", "code_information": [{"code": "93040", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTIDECTOMY FOREHEAD 15824", "code_information": [{"code": "15824", "type": "CPT"}, {"code": "1482062", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTIDECTOMY FROWN LINES 15826", "code_information": [{"code": "15826", "type": "CPT"}, {"code": "1482063", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTIDECTOMY NECK W/PLATYSMAL TIGHTNING 15825", "code_information": [{"code": "15825", "type": "CPT"}, {"code": "1482064", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTIDECTOMY SMAS FLAP 15829", "code_information": [{"code": "15829", "type": "CPT"}, {"code": "1482065", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTIDECTOMY W/CHEEK CHIN & NECK 15828", "code_information": [{"code": "15828", "type": "CPT"}, {"code": "1482066", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIM SPEED PIN 30MM STERILE 74013470", "code_information": [{"code": "74013470", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.12, "discounted_cash": 108.07, "setting": "both", "billing_class": 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{"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 244.11, "discounted_cash": 146.47, "setting": "both", "billing_class": "facility"}]}, {"description": "RING RETRACTOR LONESTAR", "code_information": [{"code": "3307G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 183.28, "discounted_cash": 109.97, "setting": "both", "billing_class": "facility"}]}, {"description": "RING RETRCT 31.8 CM X 18.3 CM ROSEN WITHOUT STAY KIT NORYL GT LF STRL DISP", "code_information": [{"code": "3304G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 193.8, "discounted_cash": 116.28, "setting": "both", "billing_class": "facility"}]}, {"description": "RING TENSION 13MM TO 11MM CAPSULAR REFORM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "ACTR11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 355.0, "discounted_cash": 213.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RING TENSION 14.5MM TO 12MM CAPSULAR REFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ACTR12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 219.81, "discounted_cash": 131.89, "setting": "both", "billing_class": "facility"}]}, {"description": "RIV3 VACCINE NO PRESERV IM", "code_information": [{"code": "90673", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIV4 VACC RECOMBINANT DNA IM", "code_information": [{"code": "90682", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RLCJ PG WCS LV BATTERY ONLY", "code_information": [{"code": "862T", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RLCJ PG WCS LV TRNSMTR ONLY", "code_information": [{"code": "863T", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RLCJ PULSE GEN ONLY ISDSS", "code_information": [{"code": "681T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMP SK TC ESP<100", "code_information": [{"code": "69727", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 9391.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 9391.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7982.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMP SK TC>=100", "code_information": [{"code": "69728", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMPLT SKL PRQ ESP", "code_information": [{"code": "69726", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 9391.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 9391.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7982.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV PRSTC MTRL/MESH ABD WALL", "code_information": [{"code": "11008", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV SK-MNT CRNL NSTM PG/RCVR", "code_information": [{"code": "61892", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV&RPLC PM DUL W/L VNT LEAD", "code_information": [{"code": "C7540", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PG WCS LV BATTERY", "code_information": [{"code": "520T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 63075.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 63075.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56768.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PG WCS LV BOTH", "code_information": [{"code": "519T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PHRNC NRV STIM LD", "code_information": [{"code": "33288", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PHRNC NRV STIM PG", "code_information": [{"code": "33287", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 37880.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 37880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34092.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL & RPL CAR MODULJ PLS GN", "code_information": [{"code": "414T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 63075.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 63075.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56768.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT DFB GEN 2 LEAD", "code_information": [{"code": "33263", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 63075.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 36437.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 63075.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56768.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT DFB GEN MLT LD", "code_information": [{"code": "33264", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 63075.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 36437.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 63075.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56768.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT TOT HRT SYS", "code_information": [{"code": "33928", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL B1 FLP/PROSTC PLATE SKL", "code_information": [{"code": "62142", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL CAR MODULJ TRANVNS ELT", "code_information": [{"code": "413T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL CARDIAC MODULJ PLS GEN", "code_information": [{"code": "412T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL DEEP RX DELIVERY DEVICE", "code_information": [{"code": "20701", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL ESOPHGL SPHNCTR DEV", "code_information": [{"code": "43285", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL HPGLSL NSTIM ARY PG", "code_information": [{"code": "64584", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL I-ARTIC RX DELIVERY DEV", "code_information": [{"code": "20705", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL IMED RX DELIVERY DEVICE", "code_information": [{"code": "20703", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL IMPLT VSTIBULAR DEV UNI", "code_information": [{"code": "726T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL IMPLTBL GLUCOSE SENSOR", "code_information": [{"code": "447T", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 4173.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL NINFCT MESH HERNIA RPR", "code_information": [{"code": "49623", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL OF SUBQ DEFIBRILLATOR", "code_information": [{"code": "33272", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PERQ LEFT HEART VAD", "code_information": [{"code": "33992", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PERQ RIGHT HEART VAD", "code_information": [{"code": "33997", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PG WCS LV BATTERY ONLY", "code_information": [{"code": "518T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PG WCS LV BOTH COMPNT", "code_information": [{"code": "861T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PHRNC NRV STIM PG ONLY", "code_information": [{"code": "33280", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PHRNC NRV STIM SYS", "code_information": [{"code": "33278", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PHRNC NRV STIM TRANSVNS", "code_information": [{"code": "33279", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL RPLCMT HRT SYS F/TRNSPL", "code_information": [{"code": "33929", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL SINUS TARSI IMPLANT", "code_information": [{"code": "510T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL SS IMPL DFB PG ONLY", "code_information": [{"code": "580T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL SUBQ CAR RHYTHM MNTR", "code_information": [{"code": "33286", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL THYRD W/AUTOTRAN PARATH", "code_information": [{"code": "C7555", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL& REPLC PULSE GEN 1 LEAD", "code_information": [{"code": "33262", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 63075.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 36437.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 63075.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56768.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL&RIMPLTJ ANT SGM IMPLT", "code_information": [{"code": "661T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 9391.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 9391.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7982.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL&RINSJ SINUS TARSI IMPLT", "code_information": [{"code": "511T", "type": "CPT"}], "standard_charges": [{"minimum": 3866.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL&RPLCMT SS IMPL DFB PG", "code_information": [{"code": "614T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 63075.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56768.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RN TELEPHONE CALLS TO DMP", "code_information": [{"code": "S0320", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROB DROP ALOKA ALPHA 6 IN PROB 667", "code_information": [{"code": "667", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3240.0, "discounted_cash": 1944.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROBOT LIN-RADSURG COM, FIRST", "code_information": [{"code": "G0339", "type": "HCPCS"}], "standard_charges": [{"minimum": 4173.0, "maximum": 7295.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROBOTIC SURGICAL SYSTEM", "code_information": [{"code": "S2900", "type": 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"BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROUTER VORTEX 4.5MM X 130MM 5 FLUTE BURR ARTHRO REPROCESS STERLING STRL", "code_information": [{"code": "H9131R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.76, "discounted_cash": 59.26, "setting": "both", "billing_class": "facility"}]}, {"description": "ROUTINE FOOTCARE PT W LOPS", "code_information": [{"code": "G0247", "type": "HCPCS"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROUX-EN-Y 47740", "code_information": [{"code": "47740", "type": "CPT"}, {"code": "1482067", "type": "CDM"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "gross_charge": 3229.0, "discounted_cash": 1937.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1775.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROUX-EN-Y W/GASTROENTEROSTOMY 47741", "code_information": [{"code": "47741", "type": "CPT"}, {"code": "1482069", "type": "CDM"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "gross_charge": 3229.0, "discounted_cash": 1937.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1775.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM 1 AREA 1 D IMG", "code_information": [{"code": "78800", "type": "CPT"}], "standard_charges": [{"minimum": 328.02, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 328.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 658.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 658.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 693.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 624.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 464.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM 2+AREA 1+D IMG", "code_information": [{"code": "78801", "type": "CPT"}], "standard_charges": [{"minimum": 1065.78, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1065.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2140.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2140.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2253.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2027.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1509.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT 1 AREA", "code_information": [{"code": "78803", "type": "CPT"}], "standard_charges": [{"minimum": 1552.94, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1552.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3119.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3119.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3283.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2954.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2199.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5810.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4938.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT 2 AREAS", "code_information": [{"code": "78831", "type": "CPT"}], "standard_charges": [{"minimum": 1609.16, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1609.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3231.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3231.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3402.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3061.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2279.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5810.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4938.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT W/CT 1", "code_information": [{"code": "78830", "type": "CPT"}], "standard_charges": [{"minimum": 1714.52, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1714.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3443.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3443.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3624.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3262.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2428.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5810.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4938.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT W/CT 2", "code_information": [{"code": "78832", "type": "CPT"}], "standard_charges": [{"minimum": 2311.82, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2311.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4643.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 4643.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4887.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 4398.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 3274.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6519.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5541.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM WHBDY 1 D IMG", "code_information": [{"code": "78802", "type": "CPT"}], "standard_charges": [{"minimum": 926.58, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 926.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1861.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1861.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1958.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1763.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1312.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5810.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4938.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM WHBDY 2+D IMG", "code_information": [{"code": "78804", "type": "CPT"}], "standard_charges": [{"minimum": 712.21, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 712.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1430.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1430.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1505.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1355.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1008.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5810.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4938.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP QUAN MEAS SINGLE AREA", "code_information": [{"code": "78835", "type": "CPT"}], "standard_charges": [{"minimum": 302.24, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 607.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 607.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 638.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 575.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 428.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RP THERAPY UNLISTED PX", "code_information": [{"code": "79999", "type": "CPT"}], "standard_charges": [{"minimum": 929.15, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1497.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3006.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3006.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3165.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2848.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2120.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1093.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 929.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPL B1 FLP/PROSTC PLATE SKL", "code_information": [{"code": "62143", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLC GTUBE NO REVJ TRC", "code_information": [{"code": "43762", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLC GTUBE REVJ GSTRST TRC", "code_information": [{"code": "43763", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLC OI IMPLT SK TC ESP>=100", "code_information": [{"code": "69730", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLCM OI IMPLT SK TC ESP<100", "code_information": [{"code": "69719", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLCMT A-VALVE TLCJ AUTOL PV", "code_information": [{"code": "33440", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLCMT OI IMPLT SKL PRQ ESP", "code_information": [{"code": "69717", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR > 10 NCR/STRN", "code_information": [{"code": "49618", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR > 10 RDC", "code_information": [{"code": "49617", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR CHOANAL ATRESIA NTRANASL", "code_information": [{"code": "30540", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR CHOANAL ATRESIA TRSNPLTN", "code_information": [{"code": "30545", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR F/E/E/N/L/M 7.6-12.5 CM", "code_information": [{"code": "12015", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR F/E/E/N/L/M >30.0 CM", "code_information": [{"code": "12018", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR FE/E/EN/L/M 20.1-30.0 CM", "code_information": [{"code": "12017", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR HERN PREEMIE REDUC", "code_information": [{"code": "49491", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR ING HERN PREMIE BLOCKED", "code_information": [{"code": "49492", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA BABY BLOCKED", "code_information": [{"code": "49496", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA BABY REDUC", "code_information": [{"code": "49495", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH<HALF VER HEIGHT", "code_information": [{"code": "40652", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH>1HALF VER HT/CPX", "code_information": [{"code": "40654", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR PARASTOMAL HERNIA RDC", "code_information": [{"code": "49621", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR PARASTOMAL HRNA NCR/STRN", "code_information": [{"code": "49622", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR PUL ART UNIFOCAL W/O CPB", "code_information": [{"code": "33925", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR S/N/A/GEN/TRK20.1-30.0CM", "code_information": [{"code": "12006", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR&REFIT SPCT PRSTH APHAKIA", "code_information": [{"code": "92371", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR&REFITG SPECT XCP APHAKIA", "code_information": [{"code": "92370", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPRDTVE MED RNA GEN PRFL 238", "code_information": [{"code": "253U", "type": "CPT"}], "standard_charges": [{"minimum": 7863.31, "maximum": 9251.56, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 9251.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7863.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSA LOWER EXTR EXAM", "code_information": [{"code": "350T", "type": "CPT"}], "standard_charges": [{"minimum": 323.24, "maximum": 380.31, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 380.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 323.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSA SPINE EXAM", "code_information": [{"code": "348T", "type": "CPT"}], "standard_charges": [{"minimum": 397.64, "maximum": 467.84, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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"billing_class": "facility"}]}, {"description": "SACRAL AWL  AWL SHAFT 624.221", "code_information": [{"code": "624.221", "type": "CDM"}], "standard_charges": [{"gross_charge": 1167.74, "discounted_cash": 700.64, "setting": "both", "billing_class": "facility"}]}, {"description": "SACRAL AWL  DEPTH ADJUSTER 624.22", "code_information": [{"code": "624.22", "type": "CDM"}], "standard_charges": [{"gross_charge": 1167.74, "discounted_cash": 700.64, "setting": "both", "billing_class": "facility"}]}, {"description": "SAFFRON ANCHOR 520350", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "520350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 208.35, "discounted_cash": 125.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SALES TAX", "code_information": [{"code": "S9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALICYLATE 80179", "code_information": [{"code": "80179", "type": "CPT"}, {"code": "46191688", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "gross_charge": 21.0, "discounted_cash": 12.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 86.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 173.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 173.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 182.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 164.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 122.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 54.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 46.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALIVA TEST, HORMONE LEVEL;", "code_information": [{"code": "S3652", "type": "HCPCS"}], "standard_charges": [{"minimum": 483.22, "maximum": 1021.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 483.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 970.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 970.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1021.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 919.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 684.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALIVARY GLAND FUNCTION EXAM", "code_information": [{"code": "78232", "type": "CPT"}], "standard_charges": [{"minimum": 196.23, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan 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394.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 394.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 414.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 373.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 277.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALIVARY GLAND IMAGING", "code_information": [{"code": "78230", "type": "CPT"}], "standard_charges": [{"minimum": 340.36, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found 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"standard_charge_dollar": 683.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 683.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 719.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 647.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 482.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALIVARY GLAND PROCEDURES", "code_information": [{"code": "139", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8517.34, "maximum": 15572.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 15572.57, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8517.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SALMONELLA ANTIBODY", "code_information": [{"code": "86768", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 45.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 90.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 90.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 95.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 86.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 64.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 38.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 32.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALPINGECTOMY-COMPLETE OR PARTIAL-UNILATERAL OR BILATERAL 58700", "code_information": [{"code": "58700", "type": "CPT"}, {"code": "1482070", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALPINGO-OOPHORECTOMY-COMPLETE OR PARTIAL-UNILATERAL OR BILATERAL 58720", "code_information": [{"code": "58720", "type": "CPT"}, {"code": "1482071", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", 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"UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALPINGOSTOMY 58770", "code_information": [{"code": "58770", "type": "CPT"}, {"code": "24609353", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, 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{"description": "SAW BLADE 5.5 X 25 X 0.4/0.6MM STRYKER (STERILE) P99-151-P35S-S", "code_information": [{"code": "P99-151-P35S-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 388.68, "discounted_cash": 233.21, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE 9 X 31 X .051M M STRYKER P99-151-P30S", "code_information": [{"code": "P99-151-P30S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 388.68, "discounted_cash": 233.21, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE 9MM OSCILLATING", "code_information": [{"code": "OSB-9S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 252.8, "discounted_cash": 151.68, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE AESCULAP - NARROW SPECIAL ORDER SAW100", "code_information": [{"code": "SAW100", "type": "CDM"}], "standard_charges": [{"gross_charge": 246.48, "discounted_cash": 147.89, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE AESCULAP - WIDE SPECIAL ORDER SAW727", "code_information": [{"code": "SAW727", "type": "CDM"}], "standard_charges": [{"gross_charge": 246.48, "discounted_cash": 147.89, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE ATTACHMENT AMSCO-HALL 114542", "code_information": [{"code": "114542", "type": "CDM"}], "standard_charges": [{"gross_charge": 222.78, "discounted_cash": 133.67, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE ATTACHMENT STRYKER 114549", "code_information": [{"code": "114549", "type": "CDM"}], "standard_charges": [{"gross_charge": 222.78, "discounted_cash": 133.67, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE BONE 16.1 X 4.5MM SAGITTAL SMALL KM-3105", "code_information": [{"code": "KM-3105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.42, "discounted_cash": 21.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE LINVATEC/ HALL- POWER PRO/ VERSIPOWER PLUS - NARROW SAW614", "code_information": [{"code": "SAW614", "type": "CDM"}], "standard_charges": [{"gross_charge": 246.48, "discounted_cash": 147.89, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE LINVATEC/ HALL- POWER PRO/ VERSIPOWER PLUS - WIDE SAW723", "code_information": [{"code": "SAW723", "type": "CDM"}], "standard_charges": [{"gross_charge": 246.48, "discounted_cash": 147.89, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE LINVATEC/ HALL- VERSIPOWER - NARROW SAW609", "code_information": [{"code": "SAW609", "type": "CDM"}], "standard_charges": [{"gross_charge": 246.48, "discounted_cash": 147.89, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE LINVATEC/ HALL- VERSIPOWER - WIDE SAW724", "code_information": [{"code": "SAW724", "type": "CDM"}], "standard_charges": [{"gross_charge": 246.48, "discounted_cash": 147.89, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE LINVATEC/HALL- MAXI DRIVER - NARROW SPECIAL ORDER SAW612", "code_information": [{"code": "SAW612", "type": "CDM"}], "standard_charges": [{"gross_charge": 246.48, "discounted_cash": 147.89, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE LINVATEC/HALL- MAXI DRIVER - WIDE SPECIAL ORDER SAW725", "code_information": [{"code": "SAW725", "type": "CDM"}], "standard_charges": [{"gross_charge": 246.48, "discounted_cash": 147.89, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE OSCILLATING LARGE STRYKER POWER 70X11.5X0.8 P99-151-P51L-S", "code_information": [{"code": "P99-151-P51L-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.9, "discounted_cash": 264.54, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE OSCILLATING SMALL STRYKER POWER 30X13X0.6 P99-151-P51S-S", "code_information": [{"code": "P99-151-P51S-S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.9, "discounted_cash": 264.54, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE STRYKER 6 - NARROW SAW606", "code_information": [{"code": "SAW606", "type": "CDM"}], "standard_charges": [{"gross_charge": 246.48, "discounted_cash": 147.89, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE STRYKER 6 - WIDE SAW706", "code_information": [{"code": "SAW706", "type": "CDM"}], "standard_charges": [{"gross_charge": 246.48, "discounted_cash": 147.89, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE STRYKER NEW 25MM 75017405", "code_information": [{"code": "75017405", "type": "CDM"}], "standard_charges": [{"gross_charge": 192.76, "discounted_cash": 115.66, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE SYNTHES/SODEM/AESCULAP-SYNTHES/SODEM/ACCULANBIOGLIDE - NARROW SPECIAL ORDER SAW611", "code_information": [{"code": "SAW611", "type": "CDM"}], "standard_charges": [{"gross_charge": 246.48, "discounted_cash": 147.89, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE SYNTHES/SODEM/AESCULAP-SYNTHES/SODEM/ACCULANBIOGLIDE - WIDE SPECIAL ORDER SAW913", "code_information": [{"code": "SAW913", "type": "CDM"}], "standard_charges": [{"gross_charge": 246.48, "discounted_cash": 147.89, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLD ZIMMER SERIES 3 VERSIPOWER PL 90X25X1. 203-97-14", "code_information": [{"code": "203-97-14", "type": "CDM"}], "standard_charges": [{"gross_charge": 363.4, "discounted_cash": 218.04, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW OSCILLATING STRYK 19MM X 90MM X 1.27MM", "code_information": [{"code": "19-0901-27Y-G1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 388.68, "discounted_cash": 233.21, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW OSTEOTOMY MICRO MT4-10+", "code_information": [{"code": "3600010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1725.84, "discounted_cash": 1035.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SAWBLADE OXF CEMENTED STRYKER", "code_information": [{"code": "502698", "type": "CDM"}], "standard_charges": [{"gross_charge": 1658.88, "discounted_cash": 995.33, "setting": "both", "billing_class": "facility"}]}, {"description": "SBRT DELIVERY", "code_information": [{"code": "77373", "type": "CPT"}], "standard_charges": [{"minimum": 2411.07, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 2411.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4842.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 4842.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 5097.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 4587.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 3415.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7736.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 6575.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBRT MANAGEMENT", "code_information": [{"code": "77435", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCLERAL REINFORCEMENT WITHOUT GRAFT 67250", "code_information": [{"code": "67250", "type": "CPT"}, {"code": "1482074", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, 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[{"gross_charge": 8190.0, "discounted_cash": 4914.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCR C/V CYTO, AUTOMATED SYS", "code_information": [{"code": "G0147", "type": "HCPCS"}], "standard_charges": [{"minimum": 43.08, "maximum": 197.03, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 93.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 187.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 187.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 197.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 177.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 132.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 50.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 43.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO, AUTOSYS, RESCR", "code_information": [{"code": "G0148", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.49, "maximum": 263.17, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 124.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 250.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 250.01, 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 247.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO,THINLAYER,RESCR", "code_information": [{"code": "G0145", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.94, "maximum": 458.62, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 216.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 435.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 435.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 458.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 412.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 307.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 77.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 65.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCR MAMMO BI INCL CAD", "code_information": [{"code": "77067", "type": "CPT"}], "standard_charges": [{"minimum": 109.06, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, 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"payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 249.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 501.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 501.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 527.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 474.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 353.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 562.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 477.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEPTIC ARTHRITIS WITH CC", "code_information": [{"code": "549", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4699.0, "maximum": 13668.24, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13668.24, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9132.43, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH 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"standard_charge_dollar": 6780.69, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 4699.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS", "code_information": [{"code": "870", "type": "MS-DRG"}], "standard_charges": [{"minimum": 46207.5, "maximum": 78900.62, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 78900.62, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 46207.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC", "code_information": [{"code": "871", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13625.98, "maximum": 22254.14, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 22254.14, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 13625.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC", "code_information": [{"code": "872", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7728.29, "maximum": 11693.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11693.6, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 7728.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTOCAINE 4% 1.7ML DENTAL CARTRIDGE", "code_information": [{"code": "MED0625", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.31, "discounted_cash": 3.19, "setting": "both", "billing_class": "facility"}]}, {"description": "SEPTOPLASTY OR SUBMUCOUS RESECTION W/ OR W/O CARTILAGE SCORING-CONTOURING-OR GRAFT 30520", "code_information": [{"code": "30520", "type": "CPT"}, {"code": "1482038", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 10356.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY OLECRANON PROCESS 24138", "code_information": [{"code": "24138", "type": "CPT"}, {"code": "1482092", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY RADIAL H/N", "code_information": [{"code": "24136", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], 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"standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERFAS ENERGY 90-S CRUISE", "code_information": [{"code": "279-401-200", "type": "CDM"}, {"code": "272", "type": "RC"}], 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"standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 223.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 448.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 448.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 472.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 425.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 316.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERIAL TONOMETRY", "code_information": [{"code": "92100", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SERIES A PAT STD 37X10 3 PEG NO/WR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "184768", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2631.2, "discounted_cash": 1578.72, "setting": "both", "billing_class": "facility"}]}, {"description": "SERIES A PAT THN 28X6.2 3 PEG NO/WR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "184782", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1983.0, "discounted_cash": 1189.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SERIES A PAT THN 34X7.8 3 PEG NO/WR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "184786", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2773.88, "discounted_cash": 1664.33, "setting": "both", "billing_class": "facility"}]}, {"description": "SERIES A PAT THN 37X8.5 3 PEG NO/WR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "184788", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2455.6, "discounted_cash": 1473.36, "setting": "both", "billing_class": "facility"}]}, {"description": "SERMORELIN ACETATE INJECTION", "code_information": [{"code": "Q0515", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 241.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 484.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 484.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 510.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 459.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 341.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 127.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 108.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERUM IMMUNOELECTROPHORESIS", "code_information": [{"code": "86320", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 108.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 218.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 218.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 230.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 207.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 154.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 87.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 74.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERV FEE BIO AVS AS AL 12MM 8 DEG 77701208", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "77701208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10884.55, "discounted_cash": 6530.73, "setting": "both", "billing_class": "facility"}]}, {"description": "SERVICES OUTSIDE US", "code_information": [{"code": "S9989", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SERVICES PROVIDED IN URGENT", "code_information": [{"code": "S9088", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SESAMOIDECTOMY-FIRST TOE 28315", "code_information": [{"code": "28315", "type": "CPT"}, {"code": 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"facility"}]}, {"description": "SET GRAFT WIRE 3MM DRILL PINS SOFT TISSUE GRAFT FXTN TRANSFIX II STRL DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR 1978S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 592.01, "discounted_cash": 355.21, "setting": "both", "billing_class": "facility"}]}, {"description": "SET HANDPIECE W/CLOXIAL INTERPULS  SUCTION", "code_information": [{"code": "210-158-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 122.35, "discounted_cash": 73.41, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IMPLANT W/ MAGNUMWIRE CO BRAID SUT LABRAFIX MINIPLUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OM-6007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1676.4, "discounted_cash": 1005.84, "setting": "both", "billing_class": "facility"}]}, {"description": "SET INFLOW TUBING THERMEDX FLUIDSMART", "code_information": [{"code": "LL0002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 372.88, "discounted_cash": 223.73, "setting": "both", "billing_class": "facility"}]}, {"description": "SET INSF SFTY PWRLOC 1IN 20GA", "code_information": [{"code": "672010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.06, "discounted_cash": 39.64, "setting": "both", "billing_class": "facility"}]}, {"description": "SET INSTRUMENT TITAN PROCEDURE 10.5MM", "code_information": [{"code": "-0304", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 731.5, "discounted_cash": 438.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SET INSTRUMENTATION ACUTRAK 4 TO 5 STANDARD", "code_information": [{"code": "AM-0000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 665.0, "discounted_cash": 399.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET INSTRUMENTS RTS LESSER MTP", "code_information": [{"code": "M04S0001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1285.2, "discounted_cash": 771.12, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IRRIGATION/CYSTOSCOPY BLADDER 77\" 06544-01", "code_information": [{"code": "6544-01", "type": "CDM"}], "standard_charges": [{"gross_charge": 25.5, "discounted_cash": 15.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IRRIGATION/CYSTOSCOPY BLADDER 77\" 06544-01", "code_information": [{"code": "6544-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.37, "discounted_cash": 20.62, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IV EXTENSION 6.5IN 0.7ML NONBOND NF VALV", "code_information": [{"code": "DYNDTC5077", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.53, "discounted_cash": 5.12, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IV EXTENSION GRAVITY TWIN-SITE 32IN", "code_information": [{"code": "12678-28", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.72, "discounted_cash": 8.83, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IV EXTENSION PCA WITH PLUNGER 2.6ML 70IN ALARIS", "code_information": [{"code": "10800173", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.98, "discounted_cash": 26.39, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IV EXTENSION PCA WITH PLUNGER 2.6ML 90IN ALARIS", "code_information": [{"code": "10800175", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.66, "discounted_cash": 24.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SET IV PCA 90 ANTI-SIPHON 30873", "code_information": [{"code": "30873", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.8, "discounted_cash": 24.48, "setting": "both", "billing_class": "facility"}]}, {"description": "SET KOLENDA SALIVARY ACCESS INTRODUCER 2.2MM X 0.018IN X 5.5CM", "code_information": [{"code": "G24129", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 545.3, "discounted_cash": 327.18, "setting": "both", "billing_class": "facility"}]}, {"description": "SET LAP-CHOLEANGIOGRAPHIC CS-01700", "code_information": [{"code": "CS-01700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 305.89, "discounted_cash": 183.53, "setting": "both", "billing_class": "facility"}]}, {"description": "SET LENS BIOM SUPER VIEW DISP", "code_information": [{"code": "40411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26459.0, "discounted_cash": 15875.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SET LOCKING CAP SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15.101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1425.0, "discounted_cash": 855.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET MED 37IN SECONDARY 10 DROPS/ML DRIP RATE MALE LUER LOCK CONNECTOR FOR USE W/", "code_information": [{"code": "2C7461", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 5.1, "discounted_cash": 3.06, "setting": "both", "billing_class": "facility"}]}, {"description": "SET NDL .75IN 19GA 8ININFUSION WING DEHP FREE NONCORNINGINJECTION", "code_information": [{"code": "2205219", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.81, "discounted_cash": 9.49, "setting": "both", "billing_class": "facility"}]}, {"description": "SET NERVE BLOCK 19GA PROLONG", "code_information": [{"code": "PL19150GC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 192.19, "discounted_cash": 115.31, "setting": "both", "billing_class": "facility"}]}, {"description": "SET NERVE BLOCK 21GA X 50MM CONTINUOUS W/ 7IN TUOHY NDL", "code_information": [{"code": "488-PL18050YGC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 144.5, "discounted_cash": 86.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SET NITROGLYCERIN 107IN 15 DROP 18.7ML SECOND PORT PLUM", "code_information": [{"code": "1187812", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 51.91, "discounted_cash": 31.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SET NITROGLYCERIN 60 DROPS PER ML 103IN W/ DUO VNT SPIKE PVC TUBING SEGMENT CLEA", "code_information": [{"code": "2C8851", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 26.3, "discounted_cash": 15.78, "setting": "both", "billing_class": "facility"}]}, {"description": "SET NOVY CORNUAL CANNULATION", "code_information": [{"code": "G17478", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 468.0, "discounted_cash": 280.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SET PIN UNIVERSAL II ECLIPSE", "code_information": [{"code": "AR-9207S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 792.95, "discounted_cash": 475.77, "setting": "both", "billing_class": "facility"}]}, {"description": "SET PIN UNIVERSAL REVERSE", "code_information": [{"code": "AR-9507S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1064.0, "discounted_cash": 638.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SET PLUG 23GA 6 BOX 3 COUNT CONSTELLATION", "code_information": [{"code": "8065750837", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 171.25, "discounted_cash": 102.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SET PLUM CLAVE YSITE 104IN NDEHP 14242 28", "code_information": [{"code": "14242-28", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 20.12, "discounted_cash": 12.07, "setting": "both", "billing_class": "facility"}]}, {"description": "SET PLUMSET YBLOOD FLR CLAVE 110", "code_information": [{"code": "14212-28", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 59.94, "discounted_cash": 35.96, "setting": "both", "billing_class": "facility"}]}, {"description": "SET PMP 104IN 19.6ML IVINFUSION W/ CONVERTIBLE PIERCING PIN AND DRIP CHMBR AND S", "code_information": [{"code": "11943-12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.33, "discounted_cash": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET PRIMARY IV PLUM 107IN", "code_information": [{"code": "14248-28", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.68, "discounted_cash": 28.61, "setting": "both", "billing_class": "facility"}]}, {"description": "SET PROCEDURE HTA GENESYS PROCERVA", "code_information": [{"code": "M006580210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2862.0, "discounted_cash": 1717.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SET PROCEDURE W/ CASSETTE DRAIN BAG AND PROCEDURE SHEATH GENESYS HTA PROCERVA", "code_information": [{"code": "M006580211", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2862.0, "discounted_cash": 1717.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SET PROCEDURE W/ M CONNECTOR MAGNUM WIRE AUTOCUFF MAGNUM PI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OM-9241", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7027.77, "discounted_cash": 4216.66, "setting": "both", "billing_class": "facility"}]}, {"description": "SET PROCESSING 125 ML CELL SAVER ELITE", "code_information": [{"code": "CSE-P-125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1296.0, "discounted_cash": 777.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SET RADIATION THERAPY FIELD", "code_information": [{"code": "77280", "type": "CPT"}], "standard_charges": [{"minimum": 317.82, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 317.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 638.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 638.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 671.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 604.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 450.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 583.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 496.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET RADIATION THERAPY FIELD", "code_information": [{"code": "77285", "type": "CPT"}], "standard_charges": [{"minimum": 414.62, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 414.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 832.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 832.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 876.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 788.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 587.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1570.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1334.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET RADIATION THERAPY FIELD", "code_information": [{"code": "77290", "type": "CPT"}], "standard_charges": [{"minimum": 622.93, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 622.93, "methodology": "fee schedule"}, 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEX CHROMATIN IDENTIFICATION", "code_information": [{"code": "88130", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, 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119.81, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER LG HEXAGONAL", "code_information": [{"code": "314.15", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 208.56, "discounted_cash": 125.14, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER T8 SLF HOLDING STARDRVINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.832.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 171.97, "discounted_cash": 103.18, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT-ANGLED LEFT 03.807.200", "code_information": [{"code": "3.807.200", "type": "CDM"}], "standard_charges": [{"gross_charge": 5732.64, "discounted_cash": 3439.58, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT-ANGLED RIGHT 03.807.100", "code_information": [{"code": "3.807.100", "type": "CDM"}], "standard_charges": [{"gross_charge": 5732.64, "discounted_cash": 3439.58, "setting": "both", "billing_class": "facility"}]}, {"description": "SHANK MAS PLIF 3Z 5.0MM X 25MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7095025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2709.2, "discounted_cash": 1625.52, "setting": "both", "billing_class": "facility"}]}, {"description": "SHANK MAS PLIF 3Z 5.0MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7095030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2631.2, "discounted_cash": 1578.72, "setting": "both", "billing_class": "facility"}]}, {"description": "SHANK MDX OSTEOGRIP 6.5X45 55900506545", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "55900506545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1725.0, "discounted_cash": 1035.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHANK RELINE-O MOD SHANK 5.5X35MM TRACTION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "13175535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVE EPIDERMAL/DERMAL LESION SINGLE FACE/EAR/NOSE/LIP 0.5CM OR LESS 11310", "code_information": [{"code": "11310", "type": "CPT"}, {"code": "1703014", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.6-1.0 CM", "code_information": [{"code": "11306", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11302", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11307", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVER 2940351 10MM 2940351", "code_information": [{"code": "2940351", "type": "CDM"}], "standard_charges": [{"gross_charge": 695.46, "discounted_cash": 417.28, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER 2941310 10MM LATERAL PADDLE 2941310", "code_information": [{"code": "2941310", "type": "CDM"}], "standard_charges": [{"gross_charge": 1220.94, "discounted_cash": 732.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER 2941608  8MM X 45MM 2941608", "code_information": [{"code": "2941608", "type": "CDM"}], "standard_charges": [{"gross_charge": 602.36, "discounted_cash": 361.42, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER 2941610 10 X 45 MM PDLE SHVR 2941610", "code_information": [{"code": "2941610", "type": "CDM"}], "standard_charges": [{"gross_charge": 602.36, "discounted_cash": 361.42, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER 2941612 12 X 45 MM PDLE SHVR 2941612", "code_information": [{"code": "2941612", "type": "CDM"}], "standard_charges": [{"gross_charge": 602.36, "discounted_cash": 361.42, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER 2941614 14 X 45 MM PDLE SHVR 2941614", "code_information": [{"code": "2941614", "type": "CDM"}], "standard_charges": [{"gross_charge": 602.36, "discounted_cash": 361.42, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER 2941616 16 X 45 MM PDLE SHVR 2941616", "code_information": [{"code": "2941616", "type": "CDM"}], "standard_charges": [{"gross_charge": 602.36, "discounted_cash": 361.42, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER 906-310 10MM 906-310", "code_information": [{"code": "906-310", "type": "CDM"}], "standard_charges": [{"gross_charge": 1053.36, "discounted_cash": 632.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER 906-312 12MM 906-312", "code_information": [{"code": "906-312", "type": "CDM"}], "standard_charges": [{"gross_charge": 1053.36, "discounted_cash": 632.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER 906-314 PLIF 906-314", "code_information": [{"code": "906-314", "type": "CDM"}], "standard_charges": [{"gross_charge": 1053.36, "discounted_cash": 632.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER 906-316 ALIF 906-316", "code_information": [{"code": "906-316", "type": "CDM"}], "standard_charges": [{"gross_charge": 1053.36, "discounted_cash": 632.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER AND TUBESET MACROHOOK 110-31-1220", "code_information": [{"code": "110-31-1220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 354.68, "discounted_cash": 212.81, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER MICROBLADE IO-FLEX SHAVER  10MM SIDE CUTTER", "code_information": [{"code": "IO-K09-CP-10SC", "type": "CDM"}], "standard_charges": [{"gross_charge": 4758.48, "discounted_cash": 2855.09, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER MICROBLADE IO-FLEX SHAVER  12MM SIDE CUTTER", "code_information": [{"code": "IO-K10-CP-12SC", "type": "CDM"}], "standard_charges": [{"gross_charge": 4758.48, "discounted_cash": 2855.09, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER MICROBLADE IO-FLEX SHAVER  5.5MM SIDE CUTTER", "code_information": [{"code": "IO-K06-CP-5.5", "type": "CDM"}], "standard_charges": [{"gross_charge": 4758.48, "discounted_cash": 2855.09, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER MICROBLADE IO-FLEX SHAVER  7.5MM SIDE CUTTER", "code_information": [{"code": "IO-K08-CP-7.5SC", "type": "CDM"}], "standard_charges": [{"gross_charge": 4758.48, "discounted_cash": 2855.09, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVER SYSTEM BLADE PREBENT GREAT WHITE CONCAVE", "code_information": [{"code": "HPS-CB02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 347.6, "discounted_cash": 208.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVING OF EPIDERMAL OR DERMAL LESION SINGLE FACE/EAR/EYE/NOSE/LIP/MUCOUS MEM. 0.6 TO 1.0CM 11311", "code_information": [{"code": "11311", "type": "CPT"}, {"code": "2189126", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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FACE/EAR/EYE/NOSE/LIP/MUCOUS MEM. OVER 2.0CM 11313", "code_information": [{"code": "11313", "type": "CPT"}, {"code": "2189127", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"type": "RC"}], "standard_charges": [{"gross_charge": 32.52, "discounted_cash": 19.51, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP LG 8 TO 10 BLUE FEM OPEN TOE CLOSED HEEL HOOK AND LOOP CLOSURE FOAM", "code_information": [{"code": "79-90197", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 25.99, "discounted_cash": 15.59, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP LG BLUE MESH TOP WOMEN LOOP AND LOCK FASTENERS DME", "code_information": [{"code": "17007", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 6.35, "discounted_cash": 3.81, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP LG SHOE SZ 11 TO 13 BLUE MALE OPEN TOE CLOSED HEEL HOOK AND LOOP CL", "code_information": [{"code": "79-90187", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 25.99, "discounted_cash": 15.59, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP LRG UNIV LF NYLON RUBBER SQUARE TOE NS", "code_information": [{"code": "79-81237", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.52, "discounted_cash": 19.51, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP MED 6 TO 8 BLUE FEM OPEN TOE CLOSED HEEL HOOK AND LOOP CLOSURE FOAM", "code_information": [{"code": "79-90195", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 25.99, "discounted_cash": 15.59, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP MED 9 TO 11 BLUE MALE OPEN TOE CLOSED HEEL HOOK AND LOOP CLOSURE FO", "code_information": [{"code": "79-90185", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 25.99, "discounted_cash": 15.59, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP SM 4 TO 6 BLUE FEM OPEN TOE CLOSED HEEL HOOK AND LOOP CLOSURE FOAM", "code_information": [{"code": "79-90193", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 25.99, "discounted_cash": 15.59, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP SM 7 TO 9 BLUE MALE OPEN TOE CLOSED HEEL HOOK AND LOOP CLOSURE FOAM", "code_information": [{"code": "79-90183", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 25.99, "discounted_cash": 15.59, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP SML UNIV LF NYLON RUBBER SQUARE TOE NS", "code_information": [{"code": "79-81233", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.52, "discounted_cash": 19.51, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP SZ 7 8 MESH TOP LOOP AND LOCK FASTENERS", "code_information": [{"code": "17005 (79-91095)", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 6.35, "discounted_cash": 3.81, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP XL CANVAS VELCRO", "code_information": [{"code": "D2021-14", "type": "CDM"}], "standard_charges": [{"gross_charge": 61.09, "discounted_cash": 36.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP XL FEMALE W/ VELCRO", "code_information": [{"code": "2021-14", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 61.09, "discounted_cash": 36.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP XL MALE CLOSED HEAL ROCKER SOLE LOOP LOCK OPEN TOE LACE UP FOAM NYL", "code_information": [{"code": "79-90188", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 25.99, "discounted_cash": 15.59, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST-OP SQUARE TOE X-LARGE", "code_information": [{"code": "79-81238", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.31, "discounted_cash": 20.59, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOECOVER ANTI SKID", "code_information": [{"code": "2854", "type": "CDM"}], "standard_charges": [{"gross_charge": 0.31, "discounted_cash": 0.19, "setting": "both", "billing_class": "facility"}]}, {"description": "SHORT  LAMINAR COUNTERHOOK B02242407", "code_information": [{"code": "B02242407", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHORT  LUMBAR LAMINAR COUNTERHOOK B02242209", "code_information": [{"code": "B02242209", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHORT  TRANSVERSE COUNTERHOOK B02242308", "code_information": [{"code": "B02242308", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHORT HUMERAL DIAPHYSIS CEMENTLESS 10 04.01.0183", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4.01.0183", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2990.0, "discounted_cash": 1794.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHORT TI AXONTM HOOK LEFT 499.407", "code_information": [{"code": "499.407", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHORT TI AXONTM HOOK RIGHT 499.406", "code_information": [{"code": "499.406", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHORTEN RADIUS & ULNA", "code_information": [{"code": "25392", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHORTEN/LENGTHEN THIGHS", "code_information": [{"code": "27468", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHORTENING OF HAND TENDON", "code_information": [{"code": "26479", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHORTENING OF TENDON-EXTENSOR-HAND OR FINGER-EACH TENDON 26477", "code_information": [{"code": "26477", "type": "CPT"}, {"code": "1482098", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHORTENING OF THIGH BONE", "code_information": [{"code": "27465", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOULDER PROSTHESIS REMOVAL", "code_information": [{"code": "23334", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding 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"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 100.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 201.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"standard_charge_dollar": 141.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 35.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 30.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIALOLITHOTOMY SUBMANDIBULAR / SUBLINGUAL / PAROTID UNCOMPLICATED 42330", "code_information": [{"code": "42330", "type": "CPT"}, {"code": "4040505", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1292.5, "maximum": 8427.0, "gross_charge": 2350.0, "discounted_cash": 1410.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/PLCMT STENT", "code_information": [{"code": "45347", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/RESECTION", "code_information": [{"code": "45349", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/SUBMUC INJ", "code_information": [{"code": "45335", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "555", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4699.0, "maximum": 15273.14, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 15273.14, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9389.33, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 4699.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC", "code_information": [{"code": "556", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4699.0, "maximum": 9260.74, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9260.74, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5634.92, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 4699.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS WITH MCC", "code_information": [{"code": "947", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8849.1, "maximum": 14588.08, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 14588.08, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8849.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [{"code": "948", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5726.67, "maximum": 9011.22, "estimated_discounted_cash": 810.63, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9011.22, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5726.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SILDENAFIL CITRATE, 25 MG", "code_information": [{"code": "S0090", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SILICONE BAND 240 (2.5 X 0.6 MM) S5.2000", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "S5.2000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 100.14, "discounted_cash": 60.08, "setting": "both", "billing_class": "facility"}]}, {"description": "SILICONE EYE SPHERE 18MM DIAMETER WITHOUT PERFORATIONS 14254", "code_information": [{"code": "14254", "type": "CDM"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 192.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SILICONE EYE SPHERE 20MM DIAMETER WITHOUT PERFORATIONS 14255", "code_information": [{"code": "14255", "type": "CDM"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 174.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SILICONE OIL REMOVAL COLLECTION", "code_information": [{"code": "30.9", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 145.6, "discounted_cash": 87.36, "setting": "both", "billing_class": "facility"}]}, {"description": "SILICONE OIL SILIKON 8.5ML 1000", "code_information": [{"code": "C1814", "type": "HCPCS"}, {"code": "8065601187", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1150.86, "discounted_cash": 690.52, "setting": "both", "billing_class": "facility"}]}, {"description": "SILICONE STRIP 4.0MM", "code_information": [{"code": "C1814", "type": "HCPCS"}, {"code": "92-10     DUTCH", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 104.4, "discounted_cash": 62.64, "setting": "both", "billing_class": "facility"}]}, {"description": "SILICONE TIRE STYLE 240", "code_information": [{"code": "C1784", "type": "HCPCS"}, {"code": "92-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 102.0, "discounted_cash": 61.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SILICONE TIRE STYLE 276", "code_information": [{"code": "C1784", "type": "HCPCS"}, {"code": "92-18", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 142.8, "discounted_cash": 85.68, "setting": "both", "billing_class": "facility"}]}, {"description": "SILICONE TIRE STYLE 287", "code_information": [{"code": "C1784", "type": "HCPCS"}, {"code": "92-17", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 142.8, "discounted_cash": 85.68, "setting": "both", "billing_class": "facility"}]}, {"description": "SILVER NITRATE APPLICATORS", "code_information": [{"code": "MED0184", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.65, "discounted_cash": 1.59, "setting": "both", "billing_class": "facility"}]}, {"description": "SILVER SULFADIAZINE CREAM/SILVADENE", "code_information": [{"code": "MED0185", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 50.02, "discounted_cash": 30.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SIMETHICONE 30ML DROPS MYLOCON", "code_information": [{"code": "MED0186", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.44, "discounted_cash": 6.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SIMPLE PERSUADER FOR CLICKX  MONOAXIAL 03.604.003", "code_information": [{"code": "3.604.003", "type": "CDM"}], "standard_charges": [{"gross_charge": 6534.0, "discounted_cash": 3920.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SIMPLE PNEUMONIA AND PLEURISY WITH CC", "code_information": [{"code": "194", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6607.47, "maximum": 9300.44, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMPLE REPAIR SUPERFICIAL WOUNDS SCALP-NECK-AXILLAE-GENITALIA-TRUNK-EXT. 12.6CM-20.0CM 12005", "code_information": [{"code": "12005", "type": "CPT"}, {"code": "1481989", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, 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4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMPLE REPAIR WOUNDS SCALP-NECK-AXILLAE-GEITALIA-TRUNK-EXT. 2.5CM OR LESS 12001", "code_information": [{"code": "12001", "type": "CPT"}, {"code": "1481990", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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"discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SIMULT PANC KIDN TRANS", "code_information": [{"code": "S2065", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT", "code_information": [{"code": "8", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 54.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 59.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 44.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "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": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS", "code_information": [{"code": "19", "type": "MS-DRG"}], "standard_charges": [{"setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 54.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "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": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 66.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 59.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 44.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SINGLE ENERGY X-RAY STUDY", "code_information": [{"code": "G0130", "type": "HCPCS"}], "standard_charges": [{"minimum": 101.22, "maximum": 214.02, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 203.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 203.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 214.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 192.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 143.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL", "code_information": [{"code": "402", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14942.0, "maximum": 29079.0, "estimated_discounted_cash": 80564.14, "setting": "inpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 29079.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 14942.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 24717.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 21343.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 20276.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 19209.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 18142.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE", "code_information": [{"code": "450", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14942.0, "maximum": 29079.0, "setting": "inpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 29079.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 14942.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 24717.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 21343.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 20276.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 19209.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 18142.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC", "code_information": [{"code": "451", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14942.0, "maximum": 29079.0, "estimated_discounted_cash": 55888.07, "setting": "inpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 29079.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 14942.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 24717.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 21343.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 20276.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 19209.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 18142.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINGLE PORT CUFF 18 INCH STERILE TOURNIQUET 20-34-712SLZ-1", "code_information": [{"code": "20-34-712SLZ-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.38, "discounted_cash": 44.03, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE PORT CUFF 30 INCH STERILE TOURNIQUET 20-34-727SLZ-1", "code_information": [{"code": "20-34-727SLZ-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.49, "discounted_cash": 50.09, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE PORT CUFF 34 INCH STERILE TOURNIQUET 20-34-728SLZ-1", "code_information": [{"code": "20-34-728SLZ-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.11, "discounted_cash": 53.47, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE TRANSFER TOE-HAND", "code_information": [{"code": "26553", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINGLE TROCAR TIP  THREADED  1.4 MM X 18 9080-18T", "code_information": [{"code": "9080-18T", "type": "CDM"}], "standard_charges": [{"gross_charge": 208.0, "discounted_cash": 124.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE TROCAR TIP  UNTHREADED  1.4 MM X 12 9080-12U", "code_information": [{"code": "9080-12U", "type": "CDM"}], "standard_charges": [{"gross_charge": 208.0, "discounted_cash": 124.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE TROCAR TIP  UNTHREADED  1.4 MM X 18 9080-18U", "code_information": [{"code": "9080-18U", "type": "CDM"}], "standard_charges": [{"gross_charge": 208.0, "discounted_cash": 124.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE AWL 10 MM 201-90115", "code_information": [{"code": "201-90115", "type": "CDM"}], "standard_charges": [{"gross_charge": 372.56, "discounted_cash": 223.54, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE AWL 2.75 MM 3001-90075", "code_information": [{"code": "3001-90075", "type": "CDM"}], "standard_charges": [{"gross_charge": 825.93, "discounted_cash": 495.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE AWL TAP 5.5 MM 1001-90070", "code_information": [{"code": "1001-90070", "type": "CDM"}], "standard_charges": [{"gross_charge": 524.29, "discounted_cash": 314.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE AWL TAP 5.5 MM 1001-90118", "code_information": [{"code": "1001-90118", "type": "CDM"}], "standard_charges": [{"gross_charge": 524.29, "discounted_cash": 314.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE AWL TAP 6.5 MM 1001-90071", "code_information": [{"code": "1001-90071", "type": "CDM"}], "standard_charges": [{"gross_charge": 524.29, "discounted_cash": 314.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE AWL TAP 6.5 MM 1001-90119", "code_information": [{"code": "1001-90119", "type": "CDM"}], "standard_charges": [{"gross_charge": 524.29, "discounted_cash": 314.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE AWL TAP 7.5 MM 1001-90072", "code_information": [{"code": "1001-90072", "type": "CDM"}], "standard_charges": [{"gross_charge": 524.29, "discounted_cash": 314.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE AWL TAP 7.5 MM 1001-90120", "code_information": [{"code": "1001-90120", "type": "CDM"}], "standard_charges": [{"gross_charge": 524.29, "discounted_cash": 314.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE BIFURCATED LIGHT CABLE - PURPLE 23-40-0010-2", "code_information": [{"code": "23-40-0010-2", "type": "CDM"}], "standard_charges": [{"gross_charge": 2218.32, "discounted_cash": 1330.99, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE FAST AWL 10 MM 201-90177", "code_information": [{"code": "201-90177", "type": "CDM"}], "standard_charges": [{"gross_charge": 538.65, "discounted_cash": 323.19, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE FIXATION PIN 100 MM 2701-90031", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2701-90031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE FIXATION PIN 110 MM 2701-90032", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2701-90032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 375.0, "discounted_cash": 225.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE FIXATION PIN 120 MM 2701-90033", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2701-90033", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 375.0, "discounted_cash": 225.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE FIXATION PIN 130 MM 2701-90034", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2701-90034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 375.0, "discounted_cash": 225.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE FIXATION PIN 140 MM 2701-90035", "code_information": [{"code": "2701-90035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 208.0, "discounted_cash": 124.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE FIXATION PIN 150 MM 2701-90036", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2701-90036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 375.0, "discounted_cash": 225.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE FIXATION PIN 160 MM 2701-90037", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2701-90037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 375.0, "discounted_cash": 225.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE FIXATION PIN 90 MM 2701-90030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2701-90030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 375.0, "discounted_cash": 225.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE FIXED AWL 20 MM 1208-90037", "code_information": [{"code": "1208-90037", "type": "CDM"}], "standard_charges": [{"gross_charge": 463.57, "discounted_cash": 278.14, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE FREEHAND AWL 20 MM 1408-90003", "code_information": [{"code": "1408-90003", "type": "CDM"}], "standard_charges": [{"gross_charge": 284.4, "discounted_cash": 170.64, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE FREEHAND TAP 2.3X10 MM 201-90117", "code_information": [{"code": "201-90117", "type": "CDM"}], "standard_charges": [{"gross_charge": 170.64, "discounted_cash": 102.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE FREEHAND TAP 4.0X10 MM 201-90027", "code_information": [{"code": "201-90027", "type": "CDM"}], "standard_charges": [{"gross_charge": 197.66, "discounted_cash": 118.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE USE LATERAL ACCESS BLADE SHIM 2701-90060", "code_information": [{"code": 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"plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN FLAP FOREHEAD-CHEEKS-CHIN-MOUTH-NECK-AXILLAE-GENITALIA-HANDS-FEET 15574", "code_information": [{"code": "15574", "type": "CPT"}, {"code": "1482117", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN FLAP SCALP-ARMS-LEGS 15572", "code_information": [{"code": "15572", "type": "CPT"}, {"code": "1482116", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [{"code": "577", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18417.53, "maximum": 30201.48, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 30201.48, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 18417.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC", "code_information": [{"code": "576", "type": "MS-DRG"}], "standard_charges": [{"minimum": 35824.34, "maximum": 61193.49, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 61193.49, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 35824.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC", "code_information": [{"code": "578", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11228.0, "maximum": 19172.52, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 19172.52, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11228.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [{"code": "574", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22356.91, "maximum": 39298.9, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 39298.9, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 22356.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC", "code_information": [{"code": "573", "type": "MS-DRG"}], "standard_charges": [{"minimum": 38546.01, "maximum": 69846.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 69846.3, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 38546.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC", "code_information": [{"code": "575", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12908.12, "maximum": 22646.57, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 22646.57, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12908.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [{"code": "623", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14116.29, "maximum": 21694.98, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 21694.98, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 14116.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [{"code": "622", "type": "MS-DRG"}], "standard_charges": [{"minimum": 27877.32, "maximum": 42441.76, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 42441.76, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 27877.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "624", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9512.64, "maximum": 11295.5, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 11295.5, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9512.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS FOR INJURIES WITH CC/MCC", "code_information": [{"code": "904", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23678.84, "maximum": 43792.6, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 43792.6, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 23678.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC", "code_information": [{"code": "905", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12985.93, "maximum": 18693.88, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 18693.88, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12985.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN PASTE CRITIC-AID ANORECTAL THICK MOISTURE BARRIER 2.5 OZ TUBE 1944", "code_information": [{"code": "1944 Paste", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.06, "discounted_cash": 7.84, "setting": "both", "billing_class": "facility"}]}, {"description": "SKIN PEEL THERAPY", "code_information": [{"code": "17360", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN SEAL PROTECT MOISTURIZR", "code_information": [{"code": "A6250", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKIN SPLT GRFT T/A/L ADD-ON", "code_information": [{"code": "15101", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT F/N/HF/G ADDL", "code_information": [{"code": "15276", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT T/A/L ADD-ON", "code_information": [{"code": "15272", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN TEST CANDIDA", "code_information": [{"code": "86485", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 182.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 367.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 367.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 386.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 347.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 258.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN TEST UNLISTED ANTIGN EA", "code_information": [{"code": "86486", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 16.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITH CC", "code_information": [{"code": "593", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8289.8, "maximum": 13867.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13867.86, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 8289.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITH MCC", "code_information": [{"code": "592", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12538.19, "maximum": 23322.55, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 23322.55, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 12538.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITHOUT CC/MCC", "code_information": [{"code": "594", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5946.87, "maximum": 9625.96, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9625.96, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5946.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKN SPLT A-GRFT F/N/HF/G ADD", "code_information": [{"code": "15121", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKN SUB GRFT F/N/HF/G CH ADD", "code_information": [{"code": "15278", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKN SUB GRFT F/N/HF/G CHILD", "code_information": [{"code": "15277", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKN SUB GRFT T/A/L CHILD ADD", "code_information": [{"code": "15274", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKULL BASE/BRAINSTEM SURGERY", "code_information": [{"code": "61575", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"billing_class": "facility"}]}, {"description": "SLP STDY UNATND W/ANAL", "code_information": [{"code": "95801", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SLP STDY UNATTENDED", "code_information": [{"code": "95800", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMALL 90 DEG. DURAL RETRACTOR E900-010", "code_information": [{"code": "E900-010", "type": "CDM"}], "standard_charges": [{"gross_charge": 403.69, "discounted_cash": 242.21, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL ADJACENT DILATOR 03.809.858", "code_information": [{"code": "3.809.858", "type": "CDM"}], "standard_charges": [{"gross_charge": 1087.94, "discounted_cash": 652.76, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL ANGLED HANDLE 05-704", "code_information": [{"code": "5-704", "type": "CDM"}], "standard_charges": [{"gross_charge": 1503.36, "discounted_cash": 902.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL ANIMAL INOCULATION", "code_information": [{"code": "87003", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 118.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 238.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 238.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 251.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 226.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 168.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 49.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 41.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44363", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44364", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44365", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44366", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44369", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44373", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44378", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44382", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee 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CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY BR/WA", "code_information": [{"code": "44381", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY/STENT", "code_information": [{"code": "44370", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL CANNULATED HANDLE 05-700", "code_information": [{"code": "5-700", "type": "CDM"}], "standard_charges": [{"gross_charge": 1503.36, "discounted_cash": 902.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL CEMENT CANNULA CNL-09", "code_information": [{"code": "CNL-09", "type": "CDM"}], "standard_charges": [{"gross_charge": 124.8, "discounted_cash": 74.88, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL COVER PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AX02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL CURETTE-ANGLED 388.173", "code_information": [{"code": "388.173", "type": "CDM"}], "standard_charges": [{"gross_charge": 1194.34, "discounted_cash": 716.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL EXTENDED BLADE LAMINA HOOK/FRONTAL 298.183", "code_information": [{"code": "298.183", "type": "CDM"}], "standard_charges": [{"gross_charge": 1260.84, "discounted_cash": 756.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL EXTENDED BLADE LAMINA HOOK/LEFT 298.181", "code_information": [{"code": "298.181", "type": "CDM"}], "standard_charges": [{"gross_charge": 1138.48, "discounted_cash": 683.09, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL EXTENDED BLADE LAMINA HOOK/RIGHT 298.182", "code_information": [{"code": "298.182", "type": "CDM"}], "standard_charges": [{"gross_charge": 1138.48, "discounted_cash": 683.09, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL FLAT BLADE 03.611.050", "code_information": [{"code": "3.611.050", "type": "CDM"}], 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1643.76, "discounted_cash": 986.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL LAMINA FINDER 6041.0299", "code_information": [{"code": "6041.0299", "type": "CDM"}], "standard_charges": [{"gross_charge": 1122.52, "discounted_cash": 673.51, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL LAMINA HOOK FRONTAL 298.312", "code_information": [{"code": "298.312", "type": "CDM"}], "standard_charges": [{"gross_charge": 1260.84, "discounted_cash": 756.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL LAMINA HOOK LEFT 298.311", "code_information": [{"code": "298.311", "type": "CDM"}], "standard_charges": [{"gross_charge": 1138.48, "discounted_cash": 683.09, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL LAMINA HOOK/DUAL-OPENING FRONTAL 298.309", "code_information": [{"code": "298.309", "type": "CDM"}], "standard_charges": [{"gross_charge": 1260.84, "discounted_cash": 756.5, "setting": 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"code_information": [{"code": "389.052", "type": "CDM"}], "standard_charges": [{"gross_charge": 1220.4, "discounted_cash": 732.24, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL TALL BODY LAMINA HOOK FRONTAL 298.173", "code_information": [{"code": "298.173", "type": "CDM"}], "standard_charges": [{"gross_charge": 1260.84, "discounted_cash": 756.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL TALL BODY LAMINA HOOK LEFT 298.171", "code_information": [{"code": "298.171", "type": "CDM"}], "standard_charges": [{"gross_charge": 1138.48, "discounted_cash": 683.09, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL TALL BODY LAMINA HOOK RIGHT 298.172", "code_information": [{"code": "298.172", "type": "CDM"}], "standard_charges": [{"gross_charge": 1138.48, "discounted_cash": 683.09, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL TALL BODY/EXTENDED BLADE LAMINA HOOK/FRONTAL 298.193", 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"code_information": [{"code": "498.943", "type": "CDM"}], "standard_charges": [{"gross_charge": 1064.0, "discounted_cash": 638.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL TI HOOK/RIGHT 498.942", "code_information": [{"code": "498.942", "type": "CDM"}], "standard_charges": [{"gross_charge": 1064.0, "discounted_cash": 638.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL TI LAMINA HOOK-FRONTAL 498.312", "code_information": [{"code": "498.312", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL TI LAMINA HOOK-LEFT 498.311", "code_information": [{"code": "498.311", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.66, "discounted_cash": 719.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL TI LAMINA HOOK/ DUAL-OPENING FRONTAL 498.309", "code_information": [{"code": "498.309", "type": 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{"description": "SMOKING CESSATION GUM", "code_information": [{"code": "S4995", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", 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4536.0, "discounted_cash": 2721.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TA6V CENTERED 46 +3MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "106-4603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3900.0, "discounted_cash": 2340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TI 12X14 7 DEGREE 6MM COALITION MIS  1136.2476", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1136.2476", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7020.0, "discounted_cash": 4212.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TI 14 X 16 7 7MM COALITION MIS 1136.4677", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1136.4677", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7020.0, "discounted_cash": 4212.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TI 5.0MM X 2MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "413.309", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 279.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TI6A14V 15MM 20MM AEQUALIS FLEX REVIVE  ARS342004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ARS342004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6403.8, "discounted_cash": 3842.28, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TIBIAL  REVISION BLOCK  10MM  R LATERAL/L MEDIAL  SIZE 6 322-10-106", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "322-10-106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER UNIVERS REVERS 39MM +6MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9505-06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER UNIVERS REVERS SPACER 36+9MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "AR-9555-09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER VERTEBRAL 12MM X 28MM X 40MM 12 DEG", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "48668122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18576.0, "discounted_cash": 11145.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER VERTEBRAL ANCHOR L 22MM X 30MM X 16MM 8DEG", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "48662168", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18576.0, "discounted_cash": 11145.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER VERTEBRAL ANCHOR-L 22MM X 30MM X 12MM 4DEG", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "48662124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18576.0, "discounted_cash": 11145.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER VERTEBRAL ANCHOR-L 22MM X 30MM X 14MM 8DEG", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "48662148", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18576.0, "discounted_cash": 11145.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER VERTEBRAL LORDOTIC AVS UNILIF 4DEG 11 X 25 X 9MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48395094", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16051.0, "discounted_cash": 9630.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER VERTIBRAL INTERBODY AVS 4DEG 10MM X 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48370104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12519.34, "discounted_cash": 7511.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACERINTERVERT 10MM X 50MM X 8DEG 18MM WIDE PEEK AVS ARIA IMP", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "48751210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACERINTERVERT 12MM X 55MM X 8DEG 18MM WIDE PEEK AVS ARIA IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48751312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15418.08, "discounted_cash": 9250.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACERINTERVERT 12MM X 60MM X 8DEG 18MM WIDE PEEK AVS ARIA IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "48751412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15418.08, "discounted_cash": 9250.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SPANNER WRENCH 687.509", "code_information": [{"code": "687.509", "type": "CDM"}], "standard_charges": [{"gross_charge": 461.36, "discounted_cash": 276.82, "setting": "both", "billing_class": "facility"}]}, {"description": "SPANNER WRENCH 693.612", "code_information": [{"code": "693.612", "type": "CDM"}], "standard_charges": [{"gross_charge": 202.24, "discounted_cash": 121.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SPARE CENTERING PIN FOR HOLLOW REAMER 309.270", "code_information": [{"code": "309.27", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.43, "discounted_cash": 197.66, "setting": "both", "billing_class": "facility"}]}, {"description": "SPATULA 9-0 PROLENE STC-6 8\" CUTTING EDGE REVERSE D9766", "code_information": [{"code": "D9766", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 448.28, "discounted_cash": 268.97, "setting": "both", "billing_class": "facility"}]}, {"description": "SPATULA 906-300", "code_information": [{"code": "906-300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1053.36, "discounted_cash": 632.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SPATULA ASSY PERMANENT CAUTERY  8MM IS400 470184", "code_information": [{"code": "470184", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4320.0, "discounted_cash": 2592.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEARS WECK-CELL  0008685", "code_information": [{"code": "8685", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.35, "discounted_cash": 18.81, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEC COLL NON-BLOOD:A/D TEST", "code_information": [{"code": "H0048", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL PUMP SERVICES", "code_information": [{"code": "99190", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL PUMP SERVICES", "code_information": [{"code": "99191", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL RADIATION DOSIMETRY", "code_information": [{"code": "77331", "type": "CPT"}], "standard_charges": [{"minimum": 203.38, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 408.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 408.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 386.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 288.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 583.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 496.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL RADIATION TREATMENT", "code_information": [{"code": "77470", "type": "CPT"}], "standard_charges": [{"minimum": 680.59, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1366.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1366.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1438.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1295.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 964.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2505.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2129.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL REPORTS OR FORMS", "code_information": [{"code": "99080", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL SUPPLIES PHYS/QHP", "code_information": [{"code": "99070", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL TELETX PORT PLAN", "code_information": [{"code": "77321", "type": "CPT"}], "standard_charges": [{"minimum": 250.66, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 250.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 503.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 503.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 529.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 476.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 355.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1570.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1334.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIALIST 100 COTTON CAST PADING 6X4YD 9086", "code_information": [{"code": "9086", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.59, "discounted_cash": 3.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECIMEN FAT STAIN", "code_information": [{"code": "89125", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 70.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 70.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 74.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "BLUE 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CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 23.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 20.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIMEN RETRIEVAL BAG 12MM 300ML TRS-ROBO-12", "code_information": [{"code": "TRS-ROBO-12", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.84, "discounted_cash": 122.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECIMEN RETRIEVAL BAG 5MM 120ML SB534", "code_information": [{"code": "SB534", "type": "CDM"}], "standard_charges": [{"gross_charge": 172.22, "discounted_cash": 103.33, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECTROPHOTOMETRY", "code_information": [{"code": "84311", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 56.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 112.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 112.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 118.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 107.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 79.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 23.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 20.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECTRUM II SUTURE PASSER 45D CRESCENT 20MM 4MM HOOK LOCK HANDLE  STERILE DISPOSABLE TEAL  MFR.CONME", "code_information": [{"code": "C6386", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 159.45, "discounted_cash": 95.67, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECTRUM SINGLE USE LOW-PRO S2", "code_information": [{"code": "270-0877", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.03, "discounted_cash": 96.62, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECTRUM SINGLUE USE LOPRO S1", "code_information": [{"code": "270-0876", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.03, "discounted_cash": 96.62, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECTRUM SUTURE HOOK DISPOSABLE LARGE CRESCENT", "code_information": [{"code": "C6387", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 159.45, "discounted_cash": 95.67, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECULUM BARRAQUER WIRE HEAVY", "code_information": [{"code": "615-W4106H0-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 128.96, "discounted_cash": 77.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECULUM VAGINAL LG PREMIUM KLEENSPECINSTR DISP", "code_information": [{"code": "59004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.46, "discounted_cash": 6.88, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECULUM VAGINAL MEDIUM DISPOSABLE 59001", "code_information": [{"code": "59001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.1, "discounted_cash": 4.86, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECULUM VAGINAL SM PREMIUM 590 SERIES KLEENSPECINSTR DISP", "code_information": [{"code": "59000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.46, "discounted_cash": 6.88, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEECH AUDIOM THRESH & RECOG", "code_information": [{"code": "211T", "type": "CPT"}], "standard_charges": [{"minimum": 108.23, "maximum": 228.83, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 108.23, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH AUDIOMETRY THRESHOLD", "code_information": [{"code": "210T", "type": "CPT"}], "standard_charges": [{"minimum": 108.23, "maximum": 228.83, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 108.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 217.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 217.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 228.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 205.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 153.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH EVALUATION COMPLEX", "code_information": [{"code": "70371", "type": "CPT"}], "standard_charges": [{"minimum": 624.34, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 1187.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 884.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1022.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 868.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH SOUND LANG COMPREHEN", "code_information": [{"code": "92523", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH THRESHOLD AUDIOMETRY", "code_information": [{"code": "92555", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH/HEARING THERAPY", "code_information": [{"code": "92507", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH/HEARING THERAPY", "code_information": [{"code": "92508", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEED CINCH CURVED NEEDLE IMP 2 FWIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1695.0, "discounted_cash": 1017.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEED GUIDE T8 2.4/2.7 X 30MM", "code_information": [{"code": "703888", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1022.72, "discounted_cash": 613.63, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEEDBRIDGE ACHILLIES SYSTEM BIO-COMP MID-SUBSTANCE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8929BC-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3621.8, "discounted_cash": 2173.08, "setting": "both", "billing_class": "facility"}]}, {"description": "SPERM ANTIBODY TEST", "code_information": [{"code": "89325", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 87.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 175.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 175.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 184.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 166.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 123.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 31.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 26.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM EVALUATION TEST", "code_information": [{"code": "89329", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 171.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 344.87, "methodology": "fee 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 243.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 57.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 48.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM IDENTIFICATION", "code_information": [{"code": "89257", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 182.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 367.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 367.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 386.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 347.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 258.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 146.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 124.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM ISOLATION COMPLEX", "code_information": [{"code": "89261", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 212.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 427.56, "methodology": "fee 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 301.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 146.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 124.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM ISOLATION SIMPLE", "code_information": [{"code": "89260", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 102.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 205.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 205.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 216.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", 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12014.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 11413.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 10813.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED PLUS HMO", "standard_charge_dollar": 10212.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL PUNCTURE LUMBAR DIAGNOSTIC 62270", "code_information": [{"code": "62270", "type": "CPT"}, {"code": "1482138", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee 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1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINAL PUNCTURE THERAPEUTIC FOR DRAINAGE OF CEREBROSPINAL FLUID 62272", "code_information": [{"code": "62272", "type": "CPT"}, {"code": "1482139", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.6, "maximum": 8427.0, "gross_charge": 912.0, "discounted_cash": 547.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF 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"standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINEGROUP ROD 40MM CONTOURED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "12-1040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3047.0, "discounted_cash": 1828.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINEGROUP ROD 60MM CONTOURED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "12-1060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3047.0, "discounted_cash": 1828.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINEGROUP ROD 65MM CONTOURED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "12-1065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 832.5, "discounted_cash": 499.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINEJET HANDPIECE MIS 20 DEG", "code_information": [{"code": "10020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4636.71, "discounted_cash": 2782.03, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINEJET HYDROSCISION HAND PI", "code_information": [{"code": "11120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5452.69, "discounted_cash": 3271.61, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINEJET QUICK CONNECT KIT", "code_information": [{"code": "SSS00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6623.87, "discounted_cash": 3974.32, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINEJET XC QUICK CONNECT KIT", "code_information": [{"code": "55500", "type": 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"210482", "type": "CDM"}], "standard_charges": [{"gross_charge": 262.31, "discounted_cash": 157.39, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIR GIGLI SAW BLADE 20 210483", "code_information": [{"code": "210483", "type": "CDM"}], "standard_charges": [{"gross_charge": 262.31, "discounted_cash": 157.39, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIRMTRY W/BRNCHDIL INF-2 YR", "code_information": [{"code": "94012", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPIROMETER INCENTIVE 4000M 8884719010", "code_information": [{"code": "8884719010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.78, "discounted_cash": 6.47, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIROMETER INCENTIVE ADULT 2500 ML 8884719011", "code_information": [{"code": "8884719011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.98, "discounted_cash": 5.99, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIROMETER INCENTIVE VOLUME 2500ML 001904A", "code_information": [{"code": "1904A", "type": "CDM"}], "standard_charges": [{"gross_charge": 11.64, "discounted_cash": 6.98, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIROMETER INCENTIVE VOLUME EXERCISE 2500ML", "code_information": [{"code": "84719025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.85, "discounted_cash": 6.51, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIROMETERINCENTIVE 2500 ML VOLDYNE BUILTIN HANDLE PARTICULATE FILTER SCREEN LF", "code_information": [{"code": "8884719025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.41, "discounted_cash": 6.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIROMETRY UP TO 2 YRS OLD", "code_information": [{"code": "94011", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLEEN IMAGING", "code_information": [{"code": "78185", "type": "CPT"}], "standard_charges": [{"minimum": 247.41, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 247.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 496.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 496.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 523.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 470.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 350.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITH CC", "code_information": [{"code": "800", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19280.71, "maximum": 33048.32, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 33048.32, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 19280.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITH MCC", "code_information": [{"code": "799", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34509.74, "maximum": 53928.94, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 53928.94, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 34509.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "801", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11423.24, "maximum": 18620.16, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 18620.16, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 11423.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLICE SPLEEN/KIDNEY VEINS", "code_information": [{"code": "37181", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLICING OF URETERS", "code_information": [{"code": "50770", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLINT 1-STEP 3IN X 12IN CASTING FOAM PADDIND LAYERED FIBERGLASS 3M SCOTCHCAST", "code_information": [{"code": "76312", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.48, "discounted_cash": 21.29, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT AIR ANKLE UNIVERSAL", "code_information": [{"code": "O2E", "type": "CDM"}], "standard_charges": [{"gross_charge": 86.84, "discounted_cash": 52.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT ANKLE 10IN DURABLE MED EQUIPMENT W/ SURROUND FLOAM", "code_information": [{"code": "79-81197", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.29, "discounted_cash": 35.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT BREEZE NASAL AIRWAY SP-79300", "code_information": [{"code": "SP-79300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 158.08, "discounted_cash": 94.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT CAST 3IN X 15IN WHT EXTRA FAST PLASTER SPECIALIST", "code_information": [{"code": "7390", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 0.73, "discounted_cash": 0.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT CAST FIBERGLASS ROLL 15 MIN SET ORTHOGLASS 3IN X 15FT WHITE", "code_information": [{"code": "ZZZSCSOG3L2H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 205.09, "discounted_cash": 123.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT COLLES LG DURABLE MED EQUIPMENT LEFT PADDED GOES UNDER CAST", "code_information": [{"code": "79-71975", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 25.75, "discounted_cash": 15.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT COLLES LG DURABLE MED EQUIPMENT LFT PADDED GOES UNDER CAST", "code_information": [{"code": "79-72117", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.66, "discounted_cash": 14.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT COLLES LG DURABLE MED EQUIPMENT RIGHT PADDED GOES UNDER CAST", "code_information": [{"code": "79-72127", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 23.65, "discounted_cash": 14.19, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT COLLES LG DURABLE SML EQUIPMENT LEFT PADDED GOES UNDER CAST", "code_information": [{"code": "79-71973", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.75, "discounted_cash": 15.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT COLLES LG DURABLE SML EQUIPMENT RIGHT PADDED GOES UNDER CAST", "code_information": [{"code": "79-71983", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.75, "discounted_cash": 15.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT COLLES LG LFT ALUMINUM FOAM", "code_information": [{"code": "9105-06", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 133.99, "discounted_cash": 80.39, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT COLLES LG RIGHT ALUMINUM FOAM", "code_information": [{"code": "9105-03", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 133.99, "discounted_cash": 80.39, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT COLLES MED DURABLE MED EQUIPMENT LFT PADDED GOES UNDER CAST", "code_information": [{"code": "79-72115", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 23.66, "discounted_cash": 14.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT COLLES MED DURABLE MED EQUIPMENT RIGHT PADDED GOES UNDER CAST", "code_information": [{"code": "79-72125", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 23.66, "discounted_cash": 14.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT COLLES MED LFT ALUMINUM FOAM", "code_information": [{"code": "9105-05", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 133.99, "discounted_cash": 80.39, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT COLLES MED RIGHT ALUMINUM FOAM", "code_information": [{"code": "9105-02", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 133.99, "discounted_cash": 80.39, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT COLLES SM LFT ALUMINUM FOAM", "code_information": [{"code": "9105-04", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 133.99, "discounted_cash": 80.39, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT COLLES SM RIGHT FOAM ALUMINUM", "code_information": [{"code": "9105-01", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 133.99, "discounted_cash": 80.39, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT FINGER 2.5IN MED SM BLUE FOUR PRONG ALUMINUM FOAM", "code_information": [{"code": "79-71884", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1.6, "discounted_cash": 0.96, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT FINGER 4 PRONG LG", "code_information": [{"code": "ORT32600L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.51, "discounted_cash": 3.91, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT FINGER CRVD COLLES LARGE LEFT", "code_information": [{"code": "79-71977", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.74, "discounted_cash": 15.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT FINGER CRVD COLLES MEDIUM RT", "code_information": [{"code": "79-71985", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.75, "discounted_cash": 15.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT FINGER CURVED 3 PADDED12PK 79-71925", "code_information": [{"code": "79-71925", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.75, "discounted_cash": 15.45, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT FINGER FROG 2.5 X 3\"", "code_information": [{"code": "ORT32200M", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.51, "discounted_cash": 3.91, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT FINGER LARGE 3.5 X 3", "code_information": [{"code": "79-71967", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.08, "discounted_cash": 3.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT FINGER SMALL 2.75 X 2.25", "code_information": [{"code": "79-71963", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.08, "discounted_cash": 3.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT FINGER STRIP PADDED 1 X 18IN", "code_information": [{"code": "ORT32100318", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.39, "discounted_cash": 4.43, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT FROG 2.5IN X 2.5IN BLUE PADDED ALUMINUM FOAM", "code_information": [{"code": "79-71965", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1.87, "discounted_cash": 1.12, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT IMMOBILIZER 15FT X 2IN ORTHO RIGHT LAT FIBERGLASS ORTHO-GLASS", "code_information": [{"code": "OG-2L1", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 84.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT IPS ORTHOG DOUBLE JAW SET LP 60-500-01-09-LP", "code_information": [{"code": "60-500-01-09-LP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3266.78, "discounted_cash": 1960.07, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT IPS ORTHOG SINGLE JAW LP 60-500-02-09-LP", "code_information": [{"code": "60-500-02-09-LP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2210.0, "discounted_cash": 1326.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT IPS ORTHOG SUPPLEMENTAL LP 60-500-03-09-LP", "code_information": [{"code": "60-500-03-09-LP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 778.31, "discounted_cash": 466.99, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT IPS PALATAL LP TI-6AL-4V 60-500-25-09-LP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "60-500-25-09-LP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12357.28, "discounted_cash": 7414.37, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT KNEE MED 16IN 16IN TO 19IN BLUE SUPER I BEAM STAYS FOAM", "code_information": [{"code": "79-80015", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 48.41, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT KNEE SM 14IN TO 16IN 16IN SUPER FOAM MESH", "code_information": [{"code": "79-80013", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 48.41, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT KNEE XL 16IN 22IN TO 26IN BLUE SUPER MEDIAL AND LAT I BEAM STAYS FOAM", "code_information": [{"code": "79-80018", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 48.41, "discounted_cash": 29.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT LEG GRN LOWER", "code_information": [{"code": "AE-1603", "type": "CDM"}], "standard_charges": [{"gross_charge": 94.43, "discounted_cash": 56.66, "setting": "both", 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 56.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 113.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 113.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 119.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS CRANIAL LESION COMPLEX", "code_information": [{"code": "61798", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS CRANIAL LESION SIMPLE", "code_information": [{"code": "61796", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS LINEAR BASED", "code_information": [{"code": "77372", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 33664.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 11099.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 22293.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 22293.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 23466.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 21120.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 15722.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 33664.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 28613.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS MULTISOURCE", "code_information": [{"code": "77371", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 49978.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 23639.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 47479.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 47479.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 49978.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 44980.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 33485.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 33664.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 28613.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "SRS SPINAL LESION", "code_information": [{"code": "63620", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS SPINAL LESION ADDL", "code_information": [{"code": "63621", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "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": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRSF2 GENE COMMON VARIANTS", "code_information": [{"code": "81348", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 513.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 436.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SS REVERE  ANGLED LAMINA HOOK  LARGE 234.957", "code_information": [{"code": "234.957", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  ANGLED LAMINA HOOK  MEDIUM 234.956", "code_information": [{"code": "234.956", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  ANGLED LAMINA HOOK  SMALL 234.955", "code_information": [{"code": "234.955", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  LAMINA HOOK  LARGE  TRANSVERSE 234.933", "code_information": [{"code": "234.933", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  LAMINA HOOK  LARGE 234.946", "code_information": [{"code": "234.946", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  LAMINA HOOK  MEDIUM  TRANSVERSE 234.932", "code_information": [{"code": "234.932", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  LAMINA HOOK  MEDIUM 234.945", "code_information": [{"code": "234.945", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  LAMINA HOOK  NARROW  LARGE 234.942", "code_information": [{"code": "234.942", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  LAMINA HOOK  NARROW  MEDIUM 234.941", "code_information": [{"code": "234.941", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  LAMINA HOOK  NARROW  SMALL 234.94", "code_information": [{"code": "234.94", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  LAMINA HOOK  SMALL  TRANSVERSE 234.931", "code_information": [{"code": "234.931", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  LAMINA HOOK  SMALL 234.944", "code_information": [{"code": "234.944", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  LAMINA HOOK  TALL BODY  LARGE 234.954", "code_information": [{"code": "234.954", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  LAMINA HOOK  TALL BODY  MEDIUM 234.953", "code_information": [{"code": "234.953", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  LAMINA HOOK  TALL BODY  SMALL 234.952", "code_information": [{"code": "234.952", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  LAMINA HOOK  UPGOING  LARGE 234.908", "code_information": [{"code": "234.908", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  LAMINA HOOK  UPGOING  MEDIUM 234.907", "code_information": [{"code": "234.907", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  LAMINA HOOK  WIDE  LARGE 234.95", "code_information": [{"code": "234.95", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  LAMINA HOOK  WIDE  MEDIUM 234.949", "code_information": [{"code": "234.949", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  LAMINA HOOK  WIDE  SMALL 234.948", "code_information": [{"code": "234.948", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  OFFSET LAMINA HOOK  LEFT 234.922", "code_information": [{"code": "234.922", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  OFFSET LAMINA HOOK  RIGHT 234.921", "code_information": [{"code": "234.921", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  PEDICLE HOOK  LARGE  TRANSVERSE 234.937", "code_information": [{"code": "234.937", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  PEDICLE HOOK  LARGE 234.929", "code_information": [{"code": "234.929", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  PEDICLE HOOK  MEDIUM  TRANSVERSE 234.936", "code_information": [{"code": "234.936", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  PEDICLE HOOK  MEDIUM 234.928", "code_information": [{"code": "234.928", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SS REVERE  PEDICLE HOOK  SMALL  TRANSVERSE 234.935", "code_information": [{"code": "234.935", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", 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HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT PLACEMT RETRO CAROTID", "code_information": [{"code": "37217", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT PLMT CTR DIALYSIS SEG", "code_information": [{"code": "36908", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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[{"gross_charge": 574.0, "discounted_cash": 344.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT ULTRA 7 X 24", "code_information": [{"code": "192-142", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 574.0, "discounted_cash": 344.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URET 4.8FR 22 CM W/ HYDROPLUS COATING WIRH BRAIDED RETRIEVAL LINE WITHOUT", "code_information": [{"code": "C1875", "type": "HCPCS"}, {"code": "M0061755510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 405.48, "discounted_cash": 243.29, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URET 4.8FR 24 CM W/ HYDROPLUS COATING WIRH BRAIDED RETRIEVAL LINE WITHOUT", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061755520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 588.21, "discounted_cash": 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[{"code": "C2617", "type": "HCPCS"}, {"code": "M0061801560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 347.48, "discounted_cash": 208.49, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL 7FR 22 CM WO GW DL DRMTR PLRS UL HDR POLARIS", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061921410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 498.08, "discounted_cash": 298.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL 7FR 24 CM WO GW DRMTR PLRS UL HDR POLARIS", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061921420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 498.08, "discounted_cash": 298.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL 8FR 30CM PIGTAIL CURVE TAPER TIP BLADDER MARK LOW PROFILE LARGE INNER 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"C2617", "type": "HCPCS"}, {"code": "M0061921250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 533.84, "discounted_cash": 320.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL POLARIS DUAL DUROMETER 7FR X 30CM", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061921450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 533.84, "discounted_cash": 320.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETERAL STENT PERCUFLEX PLUS", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061752810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.36, "discounted_cash": 247.42, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 4.8 XD 24 CM BRAIDED RETRIEVAL PERCUFLEX PLUS", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "175-552", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 432.0, "discounted_cash": 259.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 4.8FR 24 CN WO GW PRCF HDR", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061752520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.76, "discounted_cash": 219.46, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 4.8FR 26 CM WO GW PRCF HDR", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061752530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.76, "discounted_cash": 219.46, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 4.8FR 28 CM WO GW PRCF HDR", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061752540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.76, "discounted_cash": 219.46, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 5FR 28 CM WO GW PLRS ULT HDR", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061921240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 533.84, "discounted_cash": 320.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 6 X 28MM POLARIS ULTRA", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061921340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 556.76, "discounted_cash": 334.06, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 6FR 22 CM MFL SUT WO GW PRCF HDR", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061752610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.76, "discounted_cash": 219.46, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 6FR 24 CM MFL SUT WO GW PRCF HDR", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061752620", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.76, "discounted_cash": 219.46, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 6FR 26 CM MFL SUT WO GW PRCF HDR", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061752630", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.76, "discounted_cash": 219.46, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 6FR 26 CM WO GW PLRS ULT HDR", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061921330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 556.76, "discounted_cash": 334.06, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 6FR 30 CM WO GW PLRS ULT HDR", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061921350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 533.84, "discounted_cash": 320.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 7FR 22 CM MFL SUT WO GW PRCF HDR", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061752710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.76, "discounted_cash": 219.46, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 7FR 22CM CONTOUR", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061802310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.76, "discounted_cash": 219.46, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 7FR 24 CM MFL SUT WO GW PRCF HDR", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061752720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.76, "discounted_cash": 219.46, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 7FR 24CM CONTOUR", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061802320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.76, "discounted_cash": 219.46, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 7FR 26 CM MFL SUT WO GW PRCF HDR", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061752730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.76, "discounted_cash": 219.46, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 7FR 26 CM WO GW PLRS ULT HDR", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061921430", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 533.84, "discounted_cash": 320.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 7FR 26CM CONTOUR", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061802330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.76, "discounted_cash": 219.46, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 7FR 28 CM WO GW PLRS ULT HDR", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061921440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 533.84, "discounted_cash": 320.3, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 7FR 28CM CONTOUR", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061802340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.76, "discounted_cash": 219.46, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 7FR 28CM PERCULFLEX", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061752740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.76, "discounted_cash": 219.46, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 7FR 30CM CONTOUR", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061802350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.76, "discounted_cash": 219.46, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETHRAL 7FR 30CM PERCUFLEX", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061752750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.76, "discounted_cash": 219.46, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETRAL 4.8FR X 28CM PERCUFLEX PLUS", "code_information": [{"code": "C1875", "type": "HCPCS"}, {"code": "M0061755540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 405.48, "discounted_cash": 243.29, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT UTERINE 2.8CM X 3CM BLLN SI TO REDUCE UTERINE BLEEDING LF DISP", "code_information": [{"code": "J-BUS-253000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 149.76, "discounted_cash": 89.86, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT WITHOUT G.W. 8 X 22CM CONTOUR URETERAL", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061802410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.76, "discounted_cash": 219.46, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT WITHOUT G.W. 8 X 24CM CONTOUR URETERAL", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061802420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 412.36, "discounted_cash": 247.42, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT WITHOUT G.W. 8 X 28CM CONTOUR URETERAL", "code_information": [{"code": "C2617", "type": "HCPCS"}, {"code": "M0061802440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 365.76, "discounted_cash": 219.46, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT XEN GEL", "code_information": [{"code": "C1783", "type": "HCPCS"}, {"code": "5513-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5330.0, "discounted_cash": 3198.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEREOISOMER ANALYSIS", "code_information": [{"code": "80374", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEREOSCOPIC X-RAY GUIDANCE", "code_information": [{"code": "G6002", "type": "HCPCS"}], "standard_charges": [{"minimum": 213.39, "maximum": 251.06, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 251.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 213.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEREOTACTIC COMPUTER ASSISTED NAVIGATIONAL  PROCEDURE 61782", "code_information": [{"code": "61782", "type": "CPT"}, {"code": "1587116", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 14275.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEREOTACTIC COMPUTER ASSISTED PROCEDURE; SPINAL 61783", "code_information": [{"code": "61783", "type": "CPT"}, {"code": "44623922", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEREOTACTIC RADIATION TRMT", "code_information": [{"code": "77432", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STERIBRIDGE BOAT 50 X 25 X 7MM 101.05251", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "101.05251", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2240.0, "discounted_cash": 1344.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE NEEDLE 10 IN 8 GA      PRO-DENSE CDK W/OBDURATOR BLUE 12001200", "code_information": [{"code": "12001200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 208.0, "discounted_cash": 124.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE NEEDLE 10CM 8GA J-TYPE PRO-DENSE  KIT BLUE 12001208", "code_information": [{"code": "12001208", "type": "CDM"}], "standard_charges": [{"gross_charge": 149.76, "discounted_cash": 89.86, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE NEEDLE 4IN 11GA J-TYPE IGNITE  KIT PORTED TAPERED 1200BMA1", "code_information": [{"code": "1200BMA1", "type": "CDM"}], "standard_charges": [{"gross_charge": 158.08, "discounted_cash": 94.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE NEEDLE 6CM 11GA J-TYPE 12001211", "code_information": [{"code": "12001211", "type": "CDM"}], "standard_charges": [{"gross_charge": 149.76, "discounted_cash": 89.86, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE UV / BLUE LIGHT FILTERING ACR FOLDABLE ASPH WAVEFRONT-SHAPING TORIC POST CHAMBER INTRAOCULAR", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "DFT315 +16.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2786.0, "discounted_cash": 1671.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE WATER FOR INJECTION 100ML VIAL", "code_information": [{"code": "MED0191", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 22.27, "discounted_cash": 13.36, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE WATER FOR INJECTION 10ML", "code_information": [{"code": "MED0190", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.62, "discounted_cash": 2.77, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE WATER FOR INJECTION 5ML", "code_information": [{"code": "MED0192", "type": "CDM"}], "standard_charges": [{"gross_charge": 14.15, "discounted_cash": 8.49, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE WATER IRRIGATION SOL 1000ML", "code_information": [{"code": "MED0409", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.82, "discounted_cash": 8.29, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE WATER IRRIGATION SOLUTION 3,000 ML", "code_information": [{"code": "MED0801", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 47.25, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILIZATION INDICATOR CELERITY 20 STEAM PROCESS CHALLENGE FOR STEAM 25 CONTROLS LCB053", "code_information": [{"code": "LCB053", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.88, "discounted_cash": 22.73, "setting": "both", "billing_class": "facility"}]}, {"description": "STERISHOT II FILSHIE CLIP", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "AVM-951", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 834.0, "discounted_cash": 500.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STERNAL DEBRIDEMENT", "code_information": [{"code": "21627", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STETHOSCOPE ESOPHAGEAL 18FR REG TUBE 400 SERIES THERMISTOR MALE LUER FITTING PVC", "code_information": [{"code": "81-040418", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.35, "discounted_cash": 6.21, "setting": "both", "billing_class": "facility"}]}, {"description": "STETHOSCOPE ESOPHAGEAL 9FR", "code_information": [{"code": "ES1009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.4, "discounted_cash": 24.84, "setting": "both", "billing_class": "facility"}]}, {"description": "STETHOSCOPE ESOPHAGEAL WITH 400 SERIES 18 FR DYNJAES40018H", "code_information": [{"code": "DYNJAES40018H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.37, "discounted_cash": 8.02, "setting": "both", "billing_class": "facility"}]}, {"description": "STICK SWITCHING CONMED HPS-SSP", "code_information": [{"code": "HPS-SSP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 449.13, "discounted_cash": 269.48, "setting": "both", "billing_class": "facility"}]}, {"description": "STICK SWITCHING EXTRA LNG ELBOW ANKLE FOR SM JOINT ARTHROSCOPIST", "code_information": [{"code": "AR-3026", "type": "CDM"}], "standard_charges": [{"gross_charge": 410.8, "discounted_cash": 246.48, "setting": "both", "billing_class": "facility"}]}, {"description": "STIM CLIP 1100-0029", "code_information": [{"code": "1100-0029", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1077.3, "discounted_cash": 646.38, "setting": "both", "billing_class": "facility"}]}, {"description": "STIM CLIP PULSE  50110201", "code_information": [{"code": "50110201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 771.4, "discounted_cash": 462.84, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMSITE ACTIVATION CARD AM-2101", "code_information": [{"code": "AM-2101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 758.1, "discounted_cash": 454.86, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMUBLAST CB PASTE 8CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "ABS-2004-08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3697.2, "discounted_cash": 2218.32, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMUBLAST GEL 1CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "ABS-2002-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 858.0, "discounted_cash": 514.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULAN RAPID CURE 5CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "620-005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2520.0, "discounted_cash": 1512.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULANTS SYNTHETIC", "code_information": [{"code": "80371", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee 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"BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STIMULATED IUI CASE RATE", "code_information": [{"code": "S4035", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STIMULATION OF SPINAL CORD", "code_information": [{"code": "63610", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STIMULATION PACING HEART", "code_information": [{"code": "93623", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8928.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STIMULATOR CHECKPOINT NERVE  9094", "code_information": [{"code": "9094", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1316.7, "discounted_cash": 790.02, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR EXTERNAL TRIAL  1601 Axonic", "code_information": [{"code": "C1897", "type": "HCPCS"}, {"code": "1601 Axonic", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 660.0, "discounted_cash": 396.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR HFX TRIAL EXTS3500", "code_information": [{"code": "C1897", "type": "HCPCS"}, {"code": "EXTS3500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR NEEDLE 041838 FORAMN 3.5IN 20GA GLBL 6PK 041838", "code_information": [{"code": "41838", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 189.6, "discounted_cash": 113.76, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR NEURO SACRAL NERVE NON RECHARGEABLE BATTERYINTERSTIM II", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "3058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22450.0, "discounted_cash": 13470.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR TRIAL 1601", "code_information": [{"code": "C1897", "type": "HCPCS"}, {"code": "1601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 585.2, "discounted_cash": 351.12, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR TWIST CABLE VERIFY 3576", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "3576", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 252.8, "discounted_cash": 151.68, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR VERIFY EXTERNAL NEUROSTIMULATOR 353101", "code_information": [{"code": "353101", 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"case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF HIP", "code_information": [{"code": "29520", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF KNEE", "code_information": [{"code": "29530", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF SHOULDER", "code_information": [{"code": "29240", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF TOES", "code_information": [{"code": "29550", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRATAFIX  SPIRAL  MONOCRYL PLUS SXMP1B427", "code_information": [{"code": "SXMP1B427", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.77, "discounted_cash": 53.86, "setting": "both", "billing_class": "facility"}]}, {"description": "STREAMLINE MIS  CANNULATED TAP  4.0MM 04-CANNTAP-40", "code_information": [{"code": "4-CANNTAP-40", "type": "CDM"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STREAMLINE MIS  CANNULATED TAP  4.5MM 04-CANNTAP-45", "code_information": [{"code": "4-CANNTAP-45", "type": "CDM"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STREAMLINE MIS  CANNULATED TAP  5.5MM 04-CANNTAP-55", "code_information": [{"code": "4-CANNTAP-55", "type": "CDM"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STREAMLINE MIS  CANNULATED TAP  6.5MM 04-CANNTAP-65", "code_information": [{"code": "4-CANNTAP-65", "type": "CDM"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STREAMLINE MIS  CANNULATED TAP  7.5MM 04-CANNTAP-75", "code_information": [{"code": "4-CANNTAP-75", "type": "CDM"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STREAMLINE OCT   HOOK  5 MM 26-HOOK-S-5", "code_information": [{"code": "26-HOOK-S-5", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STREAMLINE OCT   HOOK  7 MM 26-HOOK-S-7", "code_information": [{"code": "26-HOOK-S-7", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STREAMLINE OCT   HOOK  LEFT NORMAL 23-HOOK-L-N", "code_information": [{"code": "23-HOOK-L-N", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STREAMLINE OCT   HOOK  RIGHT NORMAL 23-HOOK-R-N", "code_information": [{"code": "23-HOOK-R-N", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STREAMLINE OCT   HOOK  STRAIGHT NORMAL 23-HOOK-S-N", "code_information": [{"code": "23-HOOK-S-N", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STREP A DNA AMP PROBE", "code_information": [{"code": "87651", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 287.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 577.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 577.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 607.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 546.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 49.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP A DNA QUANT", "code_information": [{"code": "87652", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 329.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 122.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 103.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP B ASSAY W/OPTIC", "code_information": [{"code": "87802", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 55.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 111.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 111.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 117.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 105.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 78.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 37.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 31.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP B DNA AMP PROBE", "code_information": [{"code": "87653", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 287.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 577.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 577.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 607.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 546.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 407.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 102.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 87.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP LILIAC CREST LARGER 0056", "code_information": [{"code": "C9399", "type": "HCPCS"}, {"code": "56", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 3107.0, "discounted_cash": 1864.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STREPTOKINASE ANTIBODY", "code_information": [{"code": "86590", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 90.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 181.62, "methodology": "fee 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 37.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 31.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRESS TTE COMPLETE", "code_information": [{"code": "93351", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": 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[{"gross_charge": 4680.0, "discounted_cash": 2808.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP MESH FOR ETHICON STAPLER W/ VERITAS COLLAGEN MATRIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PSD6006ECHV", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 558.75, "discounted_cash": 335.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP OSTEO 26MM X 19MM X 7MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "109633", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2466.8, "discounted_cash": 1480.08, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP PACKING .25IN X 5YD IODOFORM WOVEN GAUZE 100PCT COTTON CURAD STRL", "code_information": [{"code": "NON256145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.1, "discounted_cash": 6.06, "setting": 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"standard_charges": [{"gross_charge": 11.33, "discounted_cash": 6.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP PACKING IODOFORM 1 4INX5YD STR C-PG145I", "code_information": [{"code": "C-PG145I", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.6, "discounted_cash": 6.36, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP PACKING SURGICAL 1 2X6 80-1451", "code_information": [{"code": "80-1451", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.36, "discounted_cash": 3.22, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP SILICONE 3.5MM X 125MM X .75MM STYLE 41 STRL DISP", "code_information": [{"code": "C1814", "type": "HCPCS"}, {"code": "S2971", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 207.0, "setting": "both", "billing_class": "facility"}]}, {"description": 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"standard_charges": [{"gross_charge": 5725.32, "discounted_cash": 3435.19, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP SPONGE DBM 5 X 50MM 100%", "code_information": [{"code": "MA74805", "type": "CDM"}], "standard_charges": [{"gross_charge": 2457.84, "discounted_cash": 1474.7, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIP SURG 1IN X 6IN COTTONOID RADIOPAQUE LF STRL DISP", "code_information": [{"code": "801453", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.98, "discounted_cash": 53.99, "setting": "both", "billing_class": "facility"}]}, {"description": "STRIPPER VEIN DISP", "code_information": [{"code": "63-4031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.64, "discounted_cash": 56.78, "setting": "both", "billing_class": "facility"}]}, {"description": "STRUT FIBULA 40MM IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": 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"RC"}], "standard_charges": [{"gross_charge": 9.35, "discounted_cash": 5.61, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET INTUBATION 14FR LUBRICATED", "code_information": [{"code": "251014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.41, "discounted_cash": 6.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET LIGHTED ADULT 15 3/4IN", "code_information": [{"code": "9-0222-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 142.9, "discounted_cash": 85.74, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET NAV.S RELINE CONSOL 11001061", "code_information": [{"code": "11001061", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2268.0, "discounted_cash": 1360.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET STRAIGHT 60 CM", "code_information": [{"code": "1123", 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"code_information": [{"code": "9560636", "type": "CDM"}], "standard_charges": [{"gross_charge": 110.66, "discounted_cash": 66.4, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLUS RHINAER  CAT840", "code_information": [{"code": "CAT840", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLUS VIVAER  CAT723", "code_information": [{"code": "CAT723", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2052.0, "discounted_cash": 1231.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUBCHONDROPLASTY KNEE KIT", "code_information": [{"code": "307.032.", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1223.6, "discounted_cash": 734.16, "setting": "both", "billing_class": "facility"}]}, {"description": "SUBCONJUNCTIVAL INJECTION 68200", "code_information": [{"code": "68200", "type": "CPT"}, {"code": "11906509", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "gross_charge": 449.0, "discounted_cash": 269.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 246.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBSTITUTE BONE 15CC HYDROSET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "397015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10540.11, "discounted_cash": 6324.07, "setting": "both", "billing_class": "facility"}]}, {"description": "SUBSTITUTE BONE 3CC HYDROSET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "397003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2515.52, "discounted_cash": 1509.31, "setting": "both", "billing_class": "facility"}]}, {"description": "SUBSTITUTE GRAFT BONE FOAM VITOSS IMP", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "2102-2201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2079.0, "discounted_cash": 1247.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/DEB", "code_information": [{"code": "29906", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/EXC", "code_information": [{"code": "29905", "type": "CPT"}], "standard_charges": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/FB RMVL", "code_information": [{"code": "29904", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee 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"plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/FUSION", "code_information": [{"code": "29907", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBTEMPORAL DECOMPRESSION", "code_information": [{"code": "61340", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUCTION ENDO 9FR MALLEABLE SUCTION STANDARD TIP LF", "code_information": [{"code": "9735016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 830.64, "discounted_cash": 498.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION FRAZIER MICROSURGERY ORTHO PROCEDURE W/ CONTROL VNT STRLINSTR", "code_information": [{"code": "DC3308", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 3.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION FRAZIER SURGICAL INSTRUMENT WITH CONTROL 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"billing_class": "facility"}]}, {"description": "SUCTION IRRIGATOR X/XI 5MM DAVINCI  X/XI", "code_information": [{"code": "478054", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1296.0, "discounted_cash": 777.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION PROBE + 50-S SWEEP 3.5MM X 135MM 0279-351-650", "code_information": [{"code": "279-351-650", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 502.74, "discounted_cash": 301.64, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION RETRACTOR 632.675", "code_information": [{"code": "632.675", "type": "CDM"}], "standard_charges": [{"gross_charge": 2931.12, "discounted_cash": 1758.67, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION TUBE STRAIGHT PROFESS", "code_information": [{"code": "6001-410-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 706.58, "discounted_cash": 423.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION TUBING 9/32IN X 20FT STERILE OR720", "code_information": [{"code": "OR720", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.81, "discounted_cash": 7.69, "setting": "both", "billing_class": "facility"}]}, {"description": "SUGARS MULTIPLE QUAL", "code_information": [{"code": "84377", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH 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8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGALLOY V-LOC 3-0 0.5 CIRC. 12IN NON-ABSORB TPR", "code_information": [{"code": "VLOCN0614", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": 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"percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY OF GREAT VESSEL", 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"CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27485", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee 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[{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 5613.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL PROCEDURE KIT ORTHALIGN PLUS NAVIGATION UNIT 403001", "code_information": [{"code": "403001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1566.0, "discounted_cash": 939.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL REPAIR OF STOMACH", "code_information": [{"code": "43501", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL SYSTEM OMNI ERGO SERIES 1-108", "code_information": 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"standard_charges": [{"gross_charge": 456.41, "discounted_cash": 273.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGIFLO 8ML HEMOSTATIC MATRIX KIT W/ THROMBIN 2994", "code_information": [{"code": "2994", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 413.98, "discounted_cash": 248.39, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGIFLO APPLICATOR MS1995", "code_information": [{"code": "MS1995", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.25, "discounted_cash": 108.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGIFOAM 8X12.5CMX10MM SPONGE", "code_information": [{"code": "MED0197", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.21, "discounted_cash": 58.33, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGILUBE 60 GM", "code_information": [{"code": "MED0549", 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": 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{"description": "TALAR BONE MILL SIZE 1 STERILE 5801.0009", "code_information": [{"code": "5801.0009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 865.83, "discounted_cash": 519.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TALAR DOME FLATCUT SIZE 2 33680032", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "33680032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13800.0, "discounted_cash": 8280.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TALAR IMPLANT RANGE FLAT-CUT SIZE 1 RIGHT 2833-2001", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "2833-2001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9702.15, "discounted_cash": 5821.29, "setting": "both", "billing_class": "facility"}]}, {"description": "TALECTOMY 28130", "code_information": [{"code": "28130", "type": "CPT"}, 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{"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TALOS  - C IBF  9X16X14MM  7 5-091614-07", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5-091614-07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4793.75, "discounted_cash": 2876.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMER TUBE LF", "code_information": [{"code": "B-7013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.66, "discounted_cash": 11.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMOXIFEN 10 MG", "code_information": [{"code": "S0187", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAMP  ANGLED  14MM CORE 651.021", "code_information": [{"code": "651.021", "type": "CDM"}], "standard_charges": [{"gross_charge": 1337.04, "discounted_cash": 802.22, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMP  ANGLED  20MM CORE 651.121", "code_information": [{"code": "651.121", "type": "CDM"}], "standard_charges": [{"gross_charge": 1952.64, "discounted_cash": 1171.58, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMP  STRAIGHT  14MM CORE 651.02", "code_information": [{"code": "651.02", "type": "CDM"}], "standard_charges": [{"gross_charge": 1103.9, "discounted_cash": 662.34, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMP  STRAIGHT  20MM CORE 651.12", "code_information": [{"code": "651.12", "type": "CDM"}], "standard_charges": [{"gross_charge": 1952.64, "discounted_cash": 1171.58, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMP 03.820.144", "code_information": [{"code": "3.820.144", "type": "CDM"}], "standard_charges": [{"gross_charge": 1071.98, "discounted_cash": 643.19, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMP 1001034 FLINX TAMP 1001034", "code_information": [{"code": "1001034", "type": "CDM"}], "standard_charges": [{"gross_charge": 224.36, "discounted_cash": 134.62, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMP 2000019 10X10MM 2000019", "code_information": [{"code": "2000019", "type": "CDM"}], "standard_charges": [{"gross_charge": 287.24, "discounted_cash": 172.34, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMP 2000020 10X15MM 2000020", "code_information": [{"code": "2000020", "type": "CDM"}], "standard_charges": [{"gross_charge": 287.24, "discounted_cash": 172.34, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMP 8750725 CURVED W/O DEPTH STOP 8750725", "code_information": [{"code": "8750725", "type": "CDM"}], "standard_charges": [{"gross_charge": 426.92, "discounted_cash": 256.15, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMP 9359003 SMALL BONE TAMP 9359003", "code_information": [{"code": "9359003", "type": "CDM"}], "standard_charges": [{"gross_charge": 645.18, "discounted_cash": 387.11, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMP 9359004 LARGE BONE TAMP 9359004", "code_information": [{"code": "9359004", "type": "CDM"}], "standard_charges": [{"gross_charge": 631.22, "discounted_cash": 378.73, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMP 9359006 SMALL J BONE TAMP 9359006", "code_information": [{"code": "9359006", "type": "CDM"}], "standard_charges": [{"gross_charge": 968.24, "discounted_cash": 580.94, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMP 9359008 LARGE J BONE TAMP 9359008", "code_information": [{"code": "9359008", "type": "CDM"}], "standard_charges": [{"gross_charge": 1001.76, "discounted_cash": 601.06, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMP 9359904 LARGE BONE TAMP 9359904", "code_information": [{"code": "9359904", "type": "CDM"}], "standard_charges": [{"gross_charge": 457.12, "discounted_cash": 274.27, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMP BONE 20/3 1 STEPINFLATABLE FX KIT KYPHX XPANDER", "code_information": [{"code": "KPX203PB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7269.52, "discounted_cash": 4361.71, "setting": "both", "billing_class": "facility"}]}, {"description": "TANGENTIAL BIOPSY OF SKIN SINGLE LESION 11102", "code_information": [{"code": "11102", "type": "CPT"}, {"code": "45432298", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 14275.0, "gross_charge": 1070.0, "discounted_cash": 642.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 588.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TANGNTL BX SKIN EA SEP/ADDL", "code_information": [{"code": "11103", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TANGORS HOOK FOR CROSSLINK CS 3005-1", "code_information": [{"code": "CS 3005-1", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TANTALUM RING APPLICATION", "code_information": [{"code": "S8030", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": 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"code_information": [{"code": "5526046", "type": "CDM"}], "standard_charges": [{"gross_charge": 395.0, "discounted_cash": 237.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  20MM 5032-0022", "code_information": [{"code": "5032-0022", "type": "CDM"}], "standard_charges": [{"gross_charge": 691.6, "discounted_cash": 414.96, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  4.5MM 7704-1024", "code_information": [{"code": "7704-1024", "type": "CDM"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  5.5MM 7704-1025", "code_information": [{"code": "7704-1025", "type": "CDM"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  5484845 G5 SEXTANT 4.5 MM TAP 5484845", "code_information": [{"code": "5484845", "type": "CDM"}], "standard_charges": [{"gross_charge": 934.8, "discounted_cash": 560.88, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  5484855 G5 SEXTANT 5.5 MM TAP 5484855", "code_information": [{"code": "5484855", "type": "CDM"}], "standard_charges": [{"gross_charge": 934.8, "discounted_cash": 560.88, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  5484865 G5 SEXTANT 6.5 MM TAP 5484865", "code_information": [{"code": "5484865", "type": "CDM"}], "standard_charges": [{"gross_charge": 934.8, "discounted_cash": 560.88, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  5484875 G5 SEXTANT 7.5 MM TAP 5484875", "code_information": [{"code": "5484875", "type": "CDM"}], "standard_charges": [{"gross_charge": 934.8, "discounted_cash": 560.88, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  6.5MM 7704-1026", "code_information": [{"code": "7704-1026", "type": "CDM"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  7.5MM 7704-1027", "code_information": [{"code": "7704-1027", "type": "CDM"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  8.5MM 7704-1028", "code_information": [{"code": "7704-1028", "type": "CDM"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  CANNULATED  4.5MM 7706-1024", "code_information": [{"code": "7706-1024", "type": "CDM"}], "standard_charges": [{"gross_charge": 625.1, "discounted_cash": 375.06, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  CANNULATED  5.5MM 7706-1025", "code_information": [{"code": "7706-1025", "type": "CDM"}], "standard_charges": [{"gross_charge": 625.1, "discounted_cash": 375.06, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  CANNULATED  6.5MM 7706-1026", "code_information": [{"code": "7706-1026", "type": "CDM"}], "standard_charges": [{"gross_charge": 625.1, "discounted_cash": 375.06, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  CANNULATED  7.5MM 7706-1027", "code_information": [{"code": "7706-1027", "type": "CDM"}], "standard_charges": [{"gross_charge": 625.1, "discounted_cash": 375.06, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  CANNULATED  AGGRESSIVE TIP  5.5MM 7706-1125", "code_information": [{"code": "7706-1125", "type": "CDM"}], "standard_charges": [{"gross_charge": 718.2, "discounted_cash": 430.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  CANNULATED  AGGRESSIVE TIP  7.5MM 7706-1127", "code_information": [{"code": "7706-1127", "type": "CDM"}], "standard_charges": [{"gross_charge": 718.2, "discounted_cash": 430.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  CANNULATED  AGGRESSIVE TP  6.5MM 7706-1126", "code_information": [{"code": "7706-1126", "type": "CDM"}], "standard_charges": [{"gross_charge": 718.2, "discounted_cash": 430.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  FLEX  OCP  STREAMLINE OCT 26-OCPFLXTAP", "code_information": [{"code": "26-OCPFLXTAP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  STANDARD  OCP  STREAMLINE OCT 26-OCPTAP", "code_information": [{"code": "26-OCPTAP", "type": "CDM"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP  STUBB  OCP  STREAMLINE OCT 26-OCPSTBTAP", "code_information": [{"code": "26-OCPSTBTAP", "type": "CDM"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 3.5MM LATERAL MASS FIXATION", "code_information": [{"code": "2883-02-035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1316.7, "discounted_cash": 790.02, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 3.9MM OMEGA 3910-947-205", "code_information": [{"code": "3910-947-205", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 446.88, "discounted_cash": 268.13, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 3030035 ZEVO 3.5MM 3030035", "code_information": [{"code": "3030035", "type": "CDM"}], "standard_charges": [{"gross_charge": 260.13, "discounted_cash": 156.08, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 4.5MM 142-00045", "code_information": [{"code": "142-00045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1129.68, "discounted_cash": 677.81, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 4.8MM 647.148", "code_information": [{"code": "647.148", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 792.68, "discounted_cash": 475.61, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 5.8MM 647.158", "code_information": [{"code": "647.158", "type": "CDM"}], "standard_charges": [{"gross_charge": 792.68, "discounted_cash": 475.61, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 5480035 3.75 DUAL LEAD TAP 5480035", "code_information": [{"code": "5480035", "type": "CDM"}], "standard_charges": [{"gross_charge": 514.36, "discounted_cash": 308.62, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 5480040 4.0 DUAL LEAD TAP 5480040", "code_information": [{"code": "5480040", "type": "CDM"}], "standard_charges": [{"gross_charge": 514.36, "discounted_cash": 308.62, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 5480045 4.5 DUAL LEAD TAP 5480045", "code_information": [{"code": "5480045", "type": "CDM"}], "standard_charges": [{"gross_charge": 514.36, "discounted_cash": 308.62, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 5480050 5.0 DUAL LEAD TAP 5480050", "code_information": [{"code": "5480050", "type": "CDM"}], "standard_charges": [{"gross_charge": 514.36, "discounted_cash": 308.62, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 5480055 5.5 DUAL LEAD TAP 5480055", "code_information": [{"code": "5480055", "type": "CDM"}], "standard_charges": [{"gross_charge": 514.36, "discounted_cash": 308.62, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 5480060 6.0 DUAL LEAD TAP 5480060", "code_information": [{"code": "5480060", "type": "CDM"}], "standard_charges": [{"gross_charge": 514.36, "discounted_cash": 308.62, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 5480065 6.5 DUAL LEAD TAP 5480065", "code_information": [{"code": "5480065", "type": "CDM"}], "standard_charges": [{"gross_charge": 514.36, "discounted_cash": 308.62, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 5480075 7.5 DUAL LEAD TAP 5480075", "code_information": [{"code": "5480075", "type": "CDM"}], "standard_charges": [{"gross_charge": 514.36, "discounted_cash": 308.62, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 5480085 8.5 DUAL LEAD TAP 5480085", "code_information": [{"code": "5480085", "type": "CDM"}], "standard_charges": [{"gross_charge": 514.36, "discounted_cash": 308.62, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 5484840 8.5 CANNULATED 5484840", "code_information": [{"code": "5484840", "type": "CDM"}], "standard_charges": [{"gross_charge": 1393.76, "discounted_cash": 836.26, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 5484841 9.5 CANNULATED 5484841", "code_information": [{"code": "5484841", "type": "CDM"}], "standard_charges": 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1443.42, "discounted_cash": 866.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 7080920 4.0 X 13MM TAP 7080920", "code_information": [{"code": "7080920", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 249.7, "discounted_cash": 149.82, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 7756300 3.0MM TAP 7756300", "code_information": [{"code": "7756300", "type": "CDM"}], "standard_charges": [{"gross_charge": 728.84, "discounted_cash": 437.3, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 7756334 4.5MM OC STR. 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[{"code": "8350055", "type": "CDM"}], "standard_charges": [{"gross_charge": 1197.89, "discounted_cash": 718.73, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 8350065 DUAL THREAD 6.5 8350065", "code_information": [{"code": "8350065", "type": "CDM"}], "standard_charges": [{"gross_charge": 1197.89, "discounted_cash": 718.73, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 8350075 DUAL THREAD 7.5 8350075", "code_information": [{"code": "8350075", "type": "CDM"}], "standard_charges": [{"gross_charge": 1197.89, "discounted_cash": 718.73, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 8350298 4.5 8350298", "code_information": [{"code": "8350298", "type": "CDM"}], "standard_charges": [{"gross_charge": 813.91, "discounted_cash": 488.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 8350299 5.5 8350299", "code_information": [{"code": "8350299", "type": "CDM"}], "standard_charges": [{"gross_charge": 813.91, "discounted_cash": 488.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 8350300 6.5 8350300", "code_information": [{"code": "8350300", "type": "CDM"}], "standard_charges": [{"gross_charge": 813.91, "discounted_cash": 488.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 8350301 7.5 8350301", "code_information": [{"code": "8350301", "type": "CDM"}], "standard_charges": [{"gross_charge": 813.91, "discounted_cash": 488.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 8350420 OSTEOGRIP THIN 3.75MM 8350420", "code_information": [{"code": "8350420", "type": "CDM"}], "standard_charges": [{"gross_charge": 487.42, "discounted_cash": 292.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 8350421 OSTEOGRIP THIN 4.0MM 8350421", "code_information": [{"code": "8350421", "type": "CDM"}], "standard_charges": [{"gross_charge": 487.42, "discounted_cash": 292.45, "setting": 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{"description": "TAP 8350426 OSTEOGRIP 6.5 MM 8350426", "code_information": [{"code": "8350426", "type": "CDM"}], "standard_charges": [{"gross_charge": 487.42, "discounted_cash": 292.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 8350427 OSTEOGRIP THIN 7.0MM 8350427", "code_information": [{"code": "8350427", "type": "CDM"}], "standard_charges": [{"gross_charge": 813.91, "discounted_cash": 488.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 8350428 OSTEOGRIP 7.5 MM 8350428", "code_information": [{"code": "8350428", "type": "CDM"}], "standard_charges": [{"gross_charge": 487.42, "discounted_cash": 292.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 8350429 OSTEOGRIP THIN 8.0MM 8350429", "code_information": [{"code": "8350429", "type": "CDM"}], "standard_charges": [{"gross_charge": 813.91, "discounted_cash": 488.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 8350430 OSTEOGRIP 8.5 MM 8350430", "code_information": [{"code": "8350430", "type": "CDM"}], "standard_charges": [{"gross_charge": 487.42, "discounted_cash": 292.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 8350432 OSTEOGRIP THIN 9.5MM 8350432", "code_information": [{"code": "8350432", "type": "CDM"}], "standard_charges": [{"gross_charge": 487.42, "discounted_cash": 292.45, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 8482910 RED MINOR DIA 6.5MM 8482910", "code_information": [{"code": "8482910", "type": "CDM"}], "standard_charges": [{"gross_charge": 1566.0, "discounted_cash": 939.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 8482912 RED MINOR DIA 7.5MM 8482912", "code_information": [{"code": "8482912", "type": "CDM"}], "standard_charges": [{"gross_charge": 1566.0, "discounted_cash": 939.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 8572030 SOLID TAP 3.75MM COLOR CODED 8572030", "code_information": [{"code": "8572030", "type": "CDM"}], "standard_charges": [{"gross_charge": 1376.35, "discounted_cash": 825.81, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 8674000 CANNULATED 4.0 8674000", "code_information": [{"code": "8674000", "type": "CDM"}], "standard_charges": [{"gross_charge": 1400.65, "discounted_cash": 840.39, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 900-243 12MM STARTER 900-243", "code_information": [{"code": "900-243", "type": "CDM"}], "standard_charges": [{"gross_charge": 1288.87, "discounted_cash": 773.32, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 900-842 18MM 900-842", "code_information": [{"code": "900-842", "type": "CDM"}], "standard_charges": [{"gross_charge": 1148.85, "discounted_cash": 689.31, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 900-843 STARTER 18MM 900-843", "code_information": [{"code": "900-843", "type": "CDM"}], "standard_charges": [{"gross_charge": 1288.87, "discounted_cash": 773.32, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 901-583 TCD ADJUSTER 22MM 901-583", "code_information": [{"code": "901-583", "type": "CDM"}], "standard_charges": [{"gross_charge": 1817.64, "discounted_cash": 1090.58, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 901-608 TCD ADJUSTER 24MM 901-608", "code_information": [{"code": "901-608", "type": "CDM"}], "standard_charges": [{"gross_charge": 1817.64, "discounted_cash": 1090.58, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 902-241 ADJUSTABLE 16MM 902-241", "code_information": [{"code": "902-241", "type": "CDM"}], "standard_charges": [{"gross_charge": 1148.85, "discounted_cash": 689.31, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 902-341 ADJUSTABLE 18MM 902-341", "code_information": [{"code": "902-341", "type": "CDM"}], "standard_charges": [{"gross_charge": 1148.85, "discounted_cash": 689.31, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 902-441 ADJUSTABLE 20MM 902-441", "code_information": [{"code": "902-441", "type": "CDM"}], "standard_charges": [{"gross_charge": 1148.85, "discounted_cash": 689.31, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 9030244 LAT THREADED 14MM 9030244", "code_information": [{"code": "9030244", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.45, "discounted_cash": 719.67, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 9030341 LAT THREADED 16MM 9030341", "code_information": [{"code": "9030341", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.45, "discounted_cash": 719.67, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 9030441 LAT L THREADED 18MM 9030441", "code_information": [{"code": "9030441", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.45, "discounted_cash": 719.67, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 9030541 LAT L THREADED 20MM 9030541", "code_information": [{"code": "9030541", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.45, "discounted_cash": 719.67, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 9112351 TCD ADJ 9112351", "code_information": [{"code": "9112351", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.45, "discounted_cash": 719.67, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 9112453 TAP TCD ADJ 9112453", "code_information": [{"code": "9112453", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.45, "discounted_cash": 719.67, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 9112551 TCD ADJ 20MM 9112551", "code_information": [{"code": "9112551", "type": "CDM"}], "standard_charges": [{"gross_charge": 1148.85, "discounted_cash": 689.31, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 9339017 8.0MM 9339017", "code_information": [{"code": "9339017", "type": "CDM"}], "standard_charges": [{"gross_charge": 1264.03, "discounted_cash": 758.42, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 9339019 9.0MM 9339019", "code_information": [{"code": "9339019", "type": "CDM"}], "standard_charges": [{"gross_charge": 1264.03, "discounted_cash": 758.42, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 9870060 6.0MM 9870060", "code_information": [{"code": "9870060", "type": "CDM"}], "standard_charges": [{"gross_charge": 1528.96, "discounted_cash": 917.38, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 9870065 6.5MM 9870065", "code_information": [{"code": "9870065", "type": "CDM"}], "standard_charges": [{"gross_charge": 1528.96, "discounted_cash": 917.38, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 9960045 4.5MM CANNULATED 9960045", "code_information": [{"code": "9960045", "type": "CDM"}], "standard_charges": [{"gross_charge": 1235.3, "discounted_cash": 741.18, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 9960055 5.5MM CANNULATED 9960055", "code_information": [{"code": "9960055", "type": "CDM"}], "standard_charges": [{"gross_charge": 1235.3, "discounted_cash": 741.18, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 9960065 6.5MM CANNULATED 9960065", "code_information": [{"code": "9960065", "type": "CDM"}], "standard_charges": [{"gross_charge": 1235.3, "discounted_cash": 741.18, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 9960070 7.0MM CANNULATED 9960070", "code_information": [{"code": "9960070", "type": "CDM"}], "standard_charges": [{"gross_charge": 1235.3, "discounted_cash": 741.18, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 9960075 7.5MM CANNULATED 9960075", "code_information": [{"code": "9960075", "type": "CDM"}], "standard_charges": [{"gross_charge": 1235.3, "discounted_cash": 741.18, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP ASSY  MODULAR  10MM 24-MODTAP-10", "code_information": [{"code": "24-MODTAP-10", "type": "CDM"}], "standard_charges": [{"gross_charge": 454.86, "discounted_cash": 272.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP ASSY  MODULAR  12MM 24-MODTAP-12", "code_information": [{"code": "24-MODTAP-12", "type": "CDM"}], "standard_charges": [{"gross_charge": 454.86, "discounted_cash": 272.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP ASSY  MODULAR  14MM 24-MODTAP-14", "code_information": [{"code": "24-MODTAP-14", "type": "CDM"}], "standard_charges": [{"gross_charge": 454.86, "discounted_cash": 272.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP ASSY  MODULAR  16MM 24-MODTAP-16", "code_information": [{"code": "24-MODTAP-16", "type": "CDM"}], "standard_charges": [{"gross_charge": 454.86, "discounted_cash": 272.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP ASSY  MODULAR  18MM 24-MODTAP-18", "code_information": [{"code": "24-MODTAP-18", "type": "CDM"}], "standard_charges": [{"gross_charge": 454.86, "discounted_cash": 272.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP ASSY  MODULAR  20MM 24-MODTAP-20", "code_information": [{"code": "24-MODTAP-20", "type": "CDM"}], "standard_charges": [{"gross_charge": 454.86, "discounted_cash": 272.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP BLOCK BI BY INFUSION", "code_information": [{"code": "64489", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 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schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB AG RESPONSE T-CELL SUSP", "code_information": [{"code": "86481", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 507.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1019.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1019.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1073.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 965.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 718.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 292.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 248.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB INTRADERMAL TEST", "code_information": [{"code": "86580", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 39.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 79.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 79.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 83.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 75.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 56.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 29.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 25.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBP GENE DETC ABNOR ALLELES", "code_information": [{"code": "81344", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 401.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 340.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBRF B GRP ANTB 4 PRTN IGG", "code_information": [{"code": "44U", "type": "CPT"}], "standard_charges": [{"minimum": 36.99, "maximum": 43.52, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 43.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 36.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBRF B GRP ANTB 4 PRTN IGM", "code_information": [{"code": "43U", "type": "CPT"}], "standard_charges": [{"minimum": 36.99, "maximum": 43.52, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 43.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 36.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBS DXA CAL W/I&R FX RISK", "code_information": [{"code": "77089", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBS I&R FX RSK QHP", "code_information": [{"code": "77092", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBS TECHL CALCULATION ONLY", "code_information": [{"code": "77091", "type": "CPT"}], "standard_charges": [{"minimum": 71.02, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 71.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 142.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 142.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 150.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 135.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 100.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 380.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 323.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBS TECHL PREP&TRANSMIS DATA", "code_information": [{"code": "77090", "type": "CPT"}], "standard_charges": [{"minimum": 71.02, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 71.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 142.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 142.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 150.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 135.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 100.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 380.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 323.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC AURICULR NEUROSTIMULATION", "code_information": [{"code": "783T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC MEAS 5 BMRK SFDI M-S ALYS", "code_information": [{"code": "61U", "type": "CPT"}], "standard_charges": [{"minimum": 62.49, "maximum": 73.52, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 73.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 62.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC REDUCTION CLAMP 03-9007-01", "code_information": [{"code": "3-9007-01", "type": "CDM"}], "standard_charges": [{"gross_charge": 7553.52, "discounted_cash": 4532.11, "setting": "both", "billing_class": "facility"}]}, {"description": "TC99M APCITIDE", "code_information": [{"code": "A9504", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M DEPREOTIDE", "code_information": [{"code": "A9536", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M DISOFENIN", "code_information": [{"code": "A9510", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M LABELED RBC", "code_information": [{"code": "A9560", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M MEBROFENIN", "code_information": [{"code": "A9537", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M MEDRONATE", "code_information": [{"code": "A9503", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M MERTIATIDE", "code_information": [{"code": "A9562", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M OXIDRONATE", "code_information": [{"code": "A9561", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M PYROPHOSPHATE", "code_information": [{"code": "A9538", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M SESTAMIBI", "code_information": [{"code": "A9500", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M TETROFOSMIN", "code_information": [{"code": "A9502", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT DLVR ENHNCD FIXJ DEV", "code_information": [{"code": "34712", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT IMPL WRLS P-ART PRS SNR", "code_information": [{"code": "33289", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 63075.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 63075.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 56768.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT IMPLTJ C SINS RDCTJ DEV", "code_information": [{"code": "645T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT INS 1CHMBR LDLS PM RA", "code_information": [{"code": "823T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM CMPL", "code_information": [{"code": "795T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM RA", "code_information": [{"code": "796T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM RV", "code_information": [{"code": "797T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT INSJ/RPL PERM LDLS PM", "code_information": [{"code": "33274", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 37880.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 37880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34092.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT INTRA-C NFS SUPERSAT O2", "code_information": [{"code": "659T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT L VENTR RSTRJ DEV IMPLT", "code_information": [{"code": "643T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT MV ANNULUS RCNSTJ", "code_information": [{"code": "544T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT PLMT&RMVL CEPD PERQ", "code_information": [{"code": "33370", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMV 1CHMBR LDLS PM RA", "code_information": [{"code": "824T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMV 2CHMBR LDLS PM CMPL", "code_information": [{"code": "798T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL 2CHMBR LDLS PM", "code_information": [{"code": "801T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL1CHMB LDLS PM RA", "code_information": [{"code": "825T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL2CHMB LDLS PM RA", "code_information": [{"code": "802T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL2CHMB LDLS PM RV", "code_information": [{"code": "803T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL 2CHMBR LDLS PM RA", "code_information": [{"code": "799T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL 2CHMBR LDLS PM RV", "code_information": [{"code": "800T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL PERM LDLS PM W/IMG", "code_information": [{"code": "33275", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL/DBLK ICAR MAS PERQ", "code_information": [{"code": "644T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT S&IVC PRSTC VL IMPL OPN", "code_information": [{"code": "806T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT S&IVC PRSTC VL IMPL PRQ", "code_information": [{"code": "805T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT TV ANNULUS RCNSTJ", "code_information": [{"code": "545T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCD EMBOLI DETECT W/INJ", "code_information": [{"code": "93893", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCD EMBOLI DETECT W/O INJ", "code_information": [{"code": "93892", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCD VASOREACTIVITY STUDY", "code_information": [{"code": "93890", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCP T10 TORX DRIVER 08-701", "code_information": [{"code": "8-701", "type": "CDM"}], "standard_charges": [{"gross_charge": 1258.18, "discounted_cash": 754.91, "setting": "both", "billing_class": "facility"}]}, {"description": "TCP T8 TORX DRIVER 08-601", "code_information": [{"code": "8-601", "type": "CDM"}], "standard_charges": [{"gross_charge": 1258.18, "discounted_cash": 754.91, "setting": "both", "billing_class": "facility"}]}, {"description": "TCRAN MAGN STIM REDETEMINE", "code_information": [{"code": "90869", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCRANIAL MAGN STIM TX DELI", "code_information": [{"code": "90868", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/O PAT BY HC PRO", "code_information": [{"code": "99368", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/O PAT BY PHYS", "code_information": [{"code": "99367", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/PAT BY HC PROF", "code_information": [{"code": "99366", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEC EYHANCE TOR II SMPLCTY 09.0D CYL2.25 DIU225 +9.0", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "DIU225 +9.0", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1785.0, "discounted_cash": 1071.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TEC EYHANCE TOR II SMPLCTY 09.5D CYL2.25 DIU225 9.5", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "DIU225 9.5", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1785.0, "discounted_cash": 1071.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TEC EYHANCE TOR II SMPLCTY 14.0D CYL1.50 DIU150U140", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "DIU150U140", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1785.0, "discounted_cash": 1071.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TEC EYHANCE TOR II SMPLCTY 14.0D CYL6.00", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "DIU600U140", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 1785.0, "discounted_cash": 1071.0, "setting": 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"TECNIS SYNERGY TORII SMPCY 15.0D CYL2.25", "code_information": [{"code": "V2787", "type": "HCPCS"}, {"code": "DFW225U150", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 2786.0, "discounted_cash": 1671.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TELAMON-P 4302614 VBS 0 26 X 14MM 4302614", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4302614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4680.0, "discounted_cash": 2808.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TELEHEALTH FACILITY FEE", "code_information": [{"code": "Q3014", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of 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{"description": "TENDON TRANSPLANTATION OR TRANSFER-FOREARM AND OR WRIST W/ GRAFTS-EACH TENDON 25312", "code_information": [{"code": "25312", "type": "CPT"}, {"code": "1482276", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDONITIS, MYOSITIS AND BURSITIS WITH MCC", "code_information": [{"code": "557", "type": "MS-DRG"}], "standard_charges": [{"minimum": 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"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC", "code_information": [{"code": "558", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4699.0, "maximum": 9797.22, "estimated_discounted_cash": 24386.22, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9797.22, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6338.09, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE HMO/PPO", "standard_charge_dollar": 5528.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED", "standard_charge_dollar": 5252.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH PLAN", "plan_name": "SCOTT AND WHITE PREFERRED HMO", "standard_charge_dollar": 4975.0, "methodology": "case rate"}, {"payer_name": "SCOTT AND WHITE HEALTH 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"standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TENODESIS BICEPS TENDON AT ELBOW 24340", "code_information": [{"code": "24340", "type": "CPT"}, {"code": "1482193", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENODESIS OF PROXIMAL INTERPHALANGEAL JOINT EACH JOINT 26471", "code_information": [{"code": "26471", "type": "CPT"}, {"code": "10710877", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.7, "maximum": 8427.0, "gross_charge": 1534.0, "discounted_cash": 920.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENODESIS PROXIMAL INTERPHALANGEAL JOINT-DISTAL JOINT 26474", "code_information": [{"code": "26474", "type": "CPT"}, {"code": "1482195", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOFOVIR LIQ CHROM UR QUAN", "code_information": [{"code": "25U", "type": "CPT"}], "standard_charges": [{"minimum": 213.47, "maximum": 251.15, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 251.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET 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"standard_charge_dollar": 58.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 17.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 14.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FOR URINE CYSTINES", "code_information": [{"code": "82615", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 66.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 134.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 134.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 141.29, "methodology": "fee 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38.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 76.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 76.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 80.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 72.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 53.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 32.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 27.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST URINE FOR PORPHYRINS", "code_information": [{"code": "84119", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, 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"standard_charge_dollar": 39.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 33.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST URINE UROBILINOGEN", "code_information": [{"code": "84578", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 17.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 35.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 35.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 37.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 33.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 25.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TESTES PROCEDURES WITH CC/MCC", "code_information": [{"code": "711", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15292.89, "maximum": 21636.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 750.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 558.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TESTOSTERONE BIOAVAILABLE", "code_information": [{"code": "84410", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 62.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 126.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 150.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 127.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TESTOSTERONE PELLET 75 MG", "code_information": [{"code": "S0189", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"plan_name": "BCBS DFW", "standard_charge_dollar": 144.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 144.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 151.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 136.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER 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188.78, "discounted_cash": 113.27, "setting": "both", "billing_class": "facility"}]}, {"description": "TGFBI GENE COMMON VARIANTS", "code_information": [{"code": "81333", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 401.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 340.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TGSAP NSM LUNG NEO DNA&RNA23", "code_information": [{"code": "22U", "type": "CPT"}], "standard_charges": [{"minimum": 146.8, "maximum": 172.72, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 700.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 630.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 469.02, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THAWING CRYOPRESRVED EMBRYO", "code_information": [{"code": "89352", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 162.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 325.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 325.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 342.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 331.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 665.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 665.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 700.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 630.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 469.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 460.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 391.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THAWING CRYOPRESRVED SPERM", "code_information": [{"code": "89353", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 58.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 117.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 117.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 123.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 111.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 82.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 146.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 124.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER IVNTJ EA ADDL 15 MIN", "code_information": [{"code": "97130", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER NMA RDCTJ INTUS/OBSTRCJ", "code_information": [{"code": "74283", "type": "CPT"}], "standard_charges": [{"minimum": 163.4, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 163.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 328.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 328.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 345.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 310.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 231.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 789.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 670.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER SPI PNXR CSF FLUOR/CT", "code_information": [{"code": "62329", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER/PROPH/DIAG INJ  EACH ADD SEQUENTIAL IV PUSH OF SAME SUBSTANCE OR DRUG 96376", "code_information": [{"code": "96376", "type": "CPT"}, {"code": "46328891", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "gross_charge": 404.0, "discounted_cash": 242.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THER/PROPH/DIAG INJ IA", "code_information": [{"code": "96373", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER/PROPH/DIAG INJ: EACH ADD SEQUENTIAL IV PUSH OF A NEW SUBSTANCE/DRUG 96375", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "42593851", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "gross_charge": 204.0, "discounted_cash": 122.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PNEUMOTHORAX", "code_information": [{"code": "32960", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PROPHY./DIAG. INJECTION I.V. PUSH SINGLE OR INITIAL SUB./DRUG 96374", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "7628439", "type": "CDM"}, {"code": "940", "type": "RC"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "gross_charge": 432.0, "discounted_cash": 259.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PROPHYLACTIC OR DIAGNOSTIC INJ. 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INJECTION I.V. PUSH SINGLE OR INITIAL SUB./DRUG 96374", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "42624978", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "gross_charge": 392.0, "discounted_cash": 235.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPUETIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION SUBCUATANEOUS OR INTRAMSUCULAR 96372", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "46328855", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "gross_charge": 202.0, "discounted_cash": 121.2, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPY ACTIVATION IPNSS", "code_information": [{"code": "93150", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPY PT MANAGER", "code_information": [{"code": "TH90T01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1803.6, "discounted_cash": 1082.16, "setting": "both", "billing_class": "facility"}]}, {"description": "THERMAL DEST. 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"billing_class": "facility"}]}, {"description": "THIN OSTEO BLADE 8 X 5 71369408", "code_information": [{"code": "71369408", "type": "CDM"}], "standard_charges": [{"gross_charge": 255.96, "discounted_cash": 153.58, "setting": "both", "billing_class": "facility"}]}, {"description": "THIN OSTEO BLD ROUND END 12MM 71369412", "code_information": [{"code": "71369412", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 255.96, "discounted_cash": 153.58, "setting": "both", "billing_class": "facility"}]}, {"description": "THIN OSTEO BLD ROUND END 20MM 71369420", "code_information": [{"code": "71369420", "type": "CDM"}], "standard_charges": [{"gross_charge": 255.96, "discounted_cash": 153.58, "setting": "both", "billing_class": "facility"}]}, {"description": "THORABD DIAPHR HERN REPAIR", "code_information": [{"code": "43336", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": 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{"description": "THORACIC AORTIC GRAFT", "code_information": [{"code": "33875", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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"plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38381", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38382", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": 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"standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACIC HOOK  NARROW  MEDIUM 51-7081", "code_information": [{"code": "51-7081", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC HOOK  NARROW  SMALL 51-7080", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "51-7080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC HOOK  WIDE  MEDIUM 51-7091", "code_information": [{"code": "51-7091", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC HOOK NARROW   45 DEG 7241121", "code_information": [{"code": "7241121", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC LAMINA HOOK FRONTAL 298.342", "code_information": [{"code": "298.342", "type": "CDM"}], "standard_charges": [{"gross_charge": 1260.84, "discounted_cash": 756.5, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC LAMINA HOOK LEFT 298.341", "code_information": [{"code": "298.341", "type": "CDM"}], "standard_charges": [{"gross_charge": 1138.48, "discounted_cash": 683.09, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC LAMINA HOOK THREADED  MEDIUM  CREO 1119.9915", "code_information": [{"code": "1119.9915", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC LAMINA HOOK THREADED  NARROW  MEDIUM  CREO 1119.9912", "code_information": [{"code": "1119.9912", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC LAMINA HOOK THREADED  NARROW  SMALL  CREO 1119.9911", "code_information": [{"code": "1119.9911", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC LAMINA HOOK THREADED  SMALL  CREO 1119.9914", "code_information": [{"code": "1119.9914", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC LAMINA HOOK/ DUAL-OPENING FRONTAL 298.339", "code_information": [{"code": "298.339", "type": "CDM"}], "standard_charges": [{"gross_charge": 1260.84, "discounted_cash": 756.5, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC LAMINA HOOK/ DUAL-OPENING SIDE 298.338", "code_information": [{"code": "298.338", "type": "CDM"}], "standard_charges": [{"gross_charge": 1260.84, "discounted_cash": 756.5, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC PEDICLE PROBE 03.622.005", "code_information": [{"code": "3.622.005", "type": "CDM"}], "standard_charges": [{"gross_charge": 954.94, "discounted_cash": 572.96, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC PROBE  CURVED 6041.0109", "code_information": [{"code": "6041.0109", "type": "CDM"}], "standard_charges": [{"gross_charge": 869.82, "discounted_cash": 521.89, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC PROBE  STRAIGHT 6041.011", "code_information": [{"code": "6041.011", "type": "CDM"}], "standard_charges": [{"gross_charge": 808.64, "discounted_cash": 485.18, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC REDUCTION HOOK  NARROW  MEDIUM 51-8081", "code_information": [{"code": "51-8081", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC REDUCTION HOOK  NARROW  SMALL 51-8080", "code_information": [{"code": "51-8080", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC REDUCTION HOOK  WIDE  MEDIUM 51-8091", "code_information": [{"code": "51-8091", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC REDUCTION HOOK  WIDE  SMALL 51-8090", "code_information": [{"code": "51-8090", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACOABDOMINAL GRAFT", "code_information": [{"code": "33877", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY 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{"description": "THORACOSCOP W/ESOPH MUSC EXC", "code_information": [{"code": "32665", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee 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"payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY CONTRL BLEEDING", "code_information": [{"code": "32654", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY DIAGNOSTIC", "code_information": [{"code": "32601", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY LYMPH NODE EXC", "code_information": [{"code": "32674", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY PNEUMONECTOMY", "code_information": [{"code": "32671", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and 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5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOV FB/FIBRIN", "code_information": [{"code": "32653", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOVE CORTEX", "code_information": [{"code": "32651", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOVE SEGMENT", "code_information": [{"code": "32669", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY RESECT BULLAE", "code_information": [{"code": "32655", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/ TH NRV EXC", "code_information": [{"code": "32664", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX MED SPACE", "code_information": [{"code": "32606", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, 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"plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX NODULE", "code_information": [{"code": "32608", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX PLEURA", "code_information": [{"code": "32609", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/EXCISION CYST TUMOR OR MASS MEDIASTINAL 32662", "code_information": [{"code": "32662", "type": "CPT"}, {"code": "1482225", "type": "CDM"}], "standard_charges": [{"minimum": 843.15, "maximum": 18989.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"facility"}]}, {"description": "THORACOSCOPY W/EXCISION PERICARDIAL CYST TUMOR OR MASS 32661", "code_information": [{"code": "32661", "type": "CPT"}, {"code": "1482226", "type": "CDM"}], "standard_charges": [{"minimum": 843.15, "maximum": 18989.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": 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{"description": "THORACOSCOPY W/THYMUS RESECT", "code_information": [{"code": "32673", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case 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8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/WEDGE RESECT", "code_information": [{"code": "32666", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY WBX SAC", "code_information": [{"code": "32604", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSTOMY W/FLAP DRAINAGE", "code_information": [{"code": "32036", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSTOMY W/RIB RESECTION", "code_information": [{"code": "32035", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO 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"UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOTOMY W/EXPLORATION 32100", "code_information": [{"code": "32100", "type": "CPT"}, {"code": "1482228", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORAX STEREO RAD TARGETW/TX", "code_information": [{"code": "32701", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THREADED HANDLE 7578011 HANDLE 7578011", "code_information": [{"code": "7578011", "type": "CDM"}], "standard_charges": [{"gross_charge": 318.62, "discounted_cash": 191.17, "setting": "both", "billing_class": "facility"}]}, {"description": "THREADED LOCKING CAP DRIVER 6067.5", "code_information": [{"code": "6067.5", "type": "CDM"}], "standard_charges": [{"gross_charge": 1155.6, "discounted_cash": 693.36, "setting": "both", "billing_class": "facility"}]}, {"description": "THREADED LOCKING CAP DRIVER 6119.5", "code_information": [{"code": "6119.5", "type": "CDM"}], "standard_charges": [{"gross_charge": 1155.6, "discounted_cash": 693.36, "setting": "both", "billing_class": "facility"}]}, {"description": "THREADED LOCKING CAP DRIVER 6120.5", "code_information": [{"code": "6120.5", "type": "CDM"}], "standard_charges": [{"gross_charge": 1155.6, "discounted_cash": 693.36, "setting": "both", "billing_class": "facility"}]}, {"description": "THREADED REDUCTION CAP DRIVER  SHAFT 624.55", "code_information": [{"code": "624.55", "type": "CDM"}], "standard_charges": [{"gross_charge": 1284.78, "discounted_cash": 770.87, "setting": "both", "billing_class": "facility"}]}, {"description": "THREADED SCREW SET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SS-219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 1680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THREADED WIRE 1.6MM 15MM THREAD 125MM LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "M743", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 336.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [{"code": "36904", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [{"code": "36905", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 37880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34092.0, "methodology": "fee 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"standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROAT X-RAY & FLUOROSCOPY", "code_information": [{"code": "70370", "type": "CPT"}], "standard_charges": [{"minimum": 192.27, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 192.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 386.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 386.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 406.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 365.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 272.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 380.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 323.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBIN TIME PLASMA", "code_information": [{"code": "85670", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 86.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 86.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 91.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 82.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 61.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 16.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 14.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBIN TIME TITER", "code_information": [{"code": "85675", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 52.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 105.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 105.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 111.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 100.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 74.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBIN TOPICAL 5,000 IU/5ML", "code_information": [{"code": "MED0201", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 182.07, "discounted_cash": 109.24, "setting": "both", "billing_class": "facility"}]}, {"description": "THROMBIN TOPICAL BOVINE 5MU REC SPRAY KIT W/DILUENT; Syringe", "code_information": [{"code": "MED0635", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 181.92, "discounted_cash": 109.15, "setting": "both", "billing_class": "facility"}]}, {"description": "THROMBLYTIC ART/VEN THERAPY", "code_information": [{"code": "37213", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC ART THERAPY", "code_information": [{"code": "37211", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC VENOUS THERAPY", "code_information": [{"code": "37212", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, 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"plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOMODULIN", "code_information": [{"code": "85337", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYMECTOMY PARTIAL OR TOTAL TRANSCERVICAL APPROACH 60520", "code_information": [{"code": "60520", "type": "CPT"}, {"code": "1482232", "type": "CDM"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3330.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4892.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6688.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6336.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4717.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYMECTOMY STERNAL SPLIT OR TRANSTHORACIC APPROACH W/O RADICAL DISSECTION 60521", "code_information": [{"code": "60521", "type": "CPT"}, {"code": "1482231", "type": "CDM"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROGLOBULIN ANTIBODY", "code_information": [{"code": "86800", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 73.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 148.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 148.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 156.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 140.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 104.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 46.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 39.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID IMAGING W/BLOOD FLOW", "code_information": [{"code": "78013", "type": "CPT"}], "standard_charges": [{"minimum": 405.68, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 405.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 814.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 814.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 857.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 771.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 574.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID IMAGING W/BLOOD FLOW", "code_information": [{"code": "78014", "type": "CPT"}], "standard_charges": [{"minimum": 470.6, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 470.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 945.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 945.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 994.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 895.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 666.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID MET IMAGING", "code_information": [{"code": "78015", "type": "CPT"}], "standard_charges": [{"minimum": 426.97, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 426.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 857.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 857.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 902.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 812.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 604.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID MET IMAGING BODY", "code_information": [{"code": "78018", "type": "CPT"}], "standard_charges": [{"minimum": 1226.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1226.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2463.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2463.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2592.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2333.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1737.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID MET IMAGING/STUDIES", "code_information": [{"code": "78016", "type": "CPT"}], "standard_charges": [{"minimum": 602.49, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 602.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1210.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1210.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1273.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1146.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 853.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 632.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 569.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 423.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, 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"plan_name": "BCBS PPO DFW", "standard_charge_dollar": 251.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 226.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 168.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", 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"gross_charge": 3229.0, "discounted_cash": 1937.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1775.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROIDECTOMY SUBTOTAL OR PARTIAL CERVICAL APPROACH 60271", "code_information": [{"code": "60271", "type": "CPT"}, {"code": "1482237", 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROIDECTOMY TOTAL OR COMPLETE 60240", "code_information": [{"code": "60240", "type": "CPT"}, {"code": "1482238", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1775.95, "maximum": 14275.0, "gross_charge": 3229.0, "discounted_cash": 1937.4, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1775.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO 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"BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1775.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, 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[{"gross_charge": 356.29, "discounted_cash": 213.77, "setting": "both", "billing_class": "facility"}]}, {"description": "TI SMALL EXTENDED BLADE LAMINA HOOK/FRONTAL 498.183", "code_information": [{"code": "498.183", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TI SMALL EXTENDED BLADE LAMINA HOOK/LEFT 498.181", "code_information": [{"code": "498.181", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.66, "discounted_cash": 719.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TI SMALL EXTENDED BLADE LAMINA HOOK/RIGHT 498.182", "code_information": [{"code": "498.182", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.66, "discounted_cash": 719.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TI SMALL TALL BODY LAMINA HOOK - FRONTAL 498.173", "code_information": [{"code": "498.173", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TI SMALL TALL BODY LAMINA HOOK LEFT 498.171", "code_information": [{"code": "498.171", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.66, "discounted_cash": 719.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TI SMALL TALL BODY LAMINA HOOK RIGHT 498.172", "code_information": [{"code": "498.172", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.66, "discounted_cash": 719.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TI SMALL TALL BODY/EXTENDED BLADE LAMINA HOOK/FRONTAL 498.193", "code_information": [{"code": "498.193", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TI SMALL TALL BODY/EXTENDED BLADE LAMINA HOOK/LEFT 498.191", "code_information": [{"code": "498.191", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.66, "discounted_cash": 719.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TI SMALL TALL BODY/EXTENDED BLADE LAMINA HOOK/RIGHT 498.192", "code_information": [{"code": "498.192", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.66, "discounted_cash": 719.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TI SURG GUIDE MANDIBLE RECON ZB-KT011", "code_information": [{"code": "ZB-KT011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8704.8, "discounted_cash": 5222.88, "setting": "both", "billing_class": "facility"}]}, {"description": "TI SURG GUIDE MIDFACE RECON ZB-KT021", "code_information": [{"code": "ZB-KT021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8704.8, "discounted_cash": 5222.88, "setting": "both", "billing_class": "facility"}]}, {"description": "TI THORACIC LAMINA HOOK- FRONTAL 498.342", "code_information": [{"code": "498.342", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TI THORACIC LAMINA HOOK-LEFT 498.341", "code_information": [{"code": "498.341", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.66, "discounted_cash": 719.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TI THORACIC LAMINA HOOK/ DUAL-OPENING FRONTAL 498.339", "code_information": [{"code": "498.339", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TI THORACIC LAMINA HOOK/ DUAL-OPENING SIDE 498.338", "code_information": [{"code": "498.338", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TI TOP LOADING LAMINA HOOK- LONG/LEFT 04.614.507", "code_information": [{"code": "4.614.507", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TI TOP LOADING LAMINA HOOK- LONG/RIGHT 04.614.506", "code_information": [{"code": "4.614.506", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TI TOP LOADING LAMINA HOOK- LONG/STRAIGHT 04.614.519", "code_information": [{"code": "4.614.519", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TI TOP LOADING LAMINA HOOK- SHORT/LEFT 04.614.505", "code_information": [{"code": "4.614.505", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TI TOP LOADING LAMINA HOOK- SHORT/RIGHT 04.614.504", "code_information": [{"code": "4.614.504", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TI TOP LOADING LAMINA HOOK- SHORT/STRAIGHT 04.614.518", "code_information": [{"code": "4.614.518", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TI TRANS-CONNECTOR CLAMP LEFT 498.951", "code_information": [{"code": "498.951", "type": "CDM"}], "standard_charges": [{"gross_charge": 837.9, "discounted_cash": 502.74, "setting": "both", "billing_class": "facility"}]}, {"description": "TI TRANSVERSE PROCESS HOOK- FRONTAL LEFT 498.383", "code_information": [{"code": "498.383", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TI TRANSVERSE PROCESS HOOK- FRONTAL RIGHT 498.382", "code_information": [{"code": "498.382", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TI TRANSVERSE PROCESS HOOK- LEFT 498.381", "code_information": [{"code": "498.381", "type": "CDM"}], "standard_charges": [{"gross_charge": 1199.66, "discounted_cash": 719.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TI TRANSVERSE PROCESS HOOK/ DUAL-OPENING FRONTAL/LEFT 498.379", "code_information": [{"code": "498.379", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TI TRANSVERSE PROCESS HOOK/ DUAL-OPENING FRONTAL/RIGHT 498.378", "code_information": [{"code": "498.378", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TI TRANSVERSE PROCESS HOOK/ DUAL-OPENING SIDE/LEFT 498.377", "code_information": [{"code": "498.377", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TI TRANSVERSE PROCESS HOOK/ DUAL-OPENING SIDE/RIGHT 498.376", "code_information": [{"code": "498.376", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TI UPGOING STARLOCK CLAMP- LEFT 498.963", "code_information": [{"code": "498.963", "type": "CDM"}], "standard_charges": [{"gross_charge": 1179.36, "discounted_cash": 707.62, "setting": "both", "billing_class": "facility"}]}, {"description": "TI UPGOING STARLOCK CLAMP- RIGHT 498.962", "code_information": [{"code": "498.962", "type": "CDM"}], "standard_charges": [{"gross_charge": 1179.36, "discounted_cash": 707.62, "setting": "both", "billing_class": "facility"}]}, {"description": "TI UPPER CLAMP 498.262", "code_information": [{"code": "498.262", "type": "CDM"}], "standard_charges": [{"gross_charge": 3257.28, "discounted_cash": 1954.37, "setting": "both", "billing_class": "facility"}]}, {"description": "TI USS FRACTURE CLAMP FOR CRANIAL END 498.833", "code_information": [{"code": "498.833", "type": "CDM"}], "standard_charges": [{"gross_charge": 1546.56, "discounted_cash": 927.94, "setting": "both", "billing_class": "facility"}]}, {"description": "TI USS LOW PROFILE FRACTURE CLAMP 498.831", "code_information": [{"code": "498.831", "type": "CDM"}], "standard_charges": [{"gross_charge": 1546.56, "discounted_cash": 927.94, "setting": "both", "billing_class": "facility"}]}, {"description": "TI USS PREASSEMBLED TRANSCONNECTOR CLAMP 498.813", "code_information": [{"code": "498.813", "type": "CDM"}], "standard_charges": [{"gross_charge": 864.5, "discounted_cash": 518.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TIB BASE SZ 2 JOURNEY UNI RT MED 44MM X 25MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71935200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5375.5, "discounted_cash": 3225.3, "setting": "both", "billing_class": "facility"}]}, {"description": "TIB INSERT SZ 1-2 9MM JOURNEY UNI RT MED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71935218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2684.5, "discounted_cash": 1610.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TIB/PER REVASC ADD-ON", "code_information": [{"code": "37232", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 21883.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 37880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 34092.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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{"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC W/ATHER", "code_information": [{"code": "37229", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee 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"setting": "both", "billing_class": "facility"}]}, {"description": "TIP PHACO 1.1MM 30DEG FLARED ROUND ABS ASPIRATING BYPASS SYS", "code_information": [{"code": "8065740806", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 323.33, "discounted_cash": 194.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP PHACOEMULSIFICATION 45DEG 0.9MM MINI FLAXED KELMAN", "code_information": [{"code": "8065750853", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.33, "discounted_cash": 105.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP RUMI UTERINE MANIPULATOR BLUE UMB678", "code_information": [{"code": "UMB678", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 172.62, "discounted_cash": 103.57, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SCREWDRIVER", "code_information": [{"code": "220-0021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 598.5, "discounted_cash": 359.1, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SENSOR .035 3CM FLEXIBLE  M0066703050", "code_information": [{"code": "M0066703050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 144.23, "discounted_cash": 86.54, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SUCT YANKAUER STANDARD BULB OPERATING ROOM WITHOUT CONTROL VNT LF STRL", "code_information": [{"code": "DYND50130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.54, "discounted_cash": 0.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SUCTION 5MM X 45 CM VENTED REG METAL FINISH", "code_information": [{"code": "250-070-408", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 313.0, "discounted_cash": 187.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SUCTION MALLEABLE STANDARD 12FR STEALTHSTATION  9735019", "code_information": [{"code": "9735019", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 830.64, "discounted_cash": 498.38, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SUCTION YANKAUER FLANGE TIP STANDARD FLEXIBLE LF", "code_information": [{"code": "DYND50143", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.16, "discounted_cash": 1.3, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SWITCHABLE 90MM 1.5MM SIDE FIRING OMNITIP SJ", "code_information": [{"code": "20496-HP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 665.0, "discounted_cash": 399.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIPINSERTER 5MM MED SPINAL STRL", "code_information": [{"code": "3.820.130S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 576.0, "discounted_cash": 345.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TIPINSTR SURG OMNISWITCH TIP", "code_information": [{"code": "20373HP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1232.04, "discounted_cash": 739.22, "setting": "both", "billing_class": "facility"}]}, {"description": "TIRE CONCAVE 2.5MM STYLE 240 CIRCLING BAND SILICONE STRL DISP", "code_information": [{"code": "C1784", "type": "HCPCS"}, {"code": "S2987", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 80.4, "discounted_cash": 48.24, "setting": "both", "billing_class": "facility"}]}, {"description": "TIRE CONVEX STYLE 287 SILICONE STRL", "code_information": [{"code": "C1784", "type": "HCPCS"}, {"code": "S3014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 392.0, "discounted_cash": 235.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TIS CGEN CAR ANOMAL 1ST SHNT", "code_information": [{"code": "33745", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIS CGEN CAR ANOMAL EA ADDL", "code_information": [{"code": "33746", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": 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"standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee 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MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS EX MOLECUL STUDY ADD-ON", "code_information": [{"code": "88388", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 40.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 34.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS EXAM MOLECULAR STUDY", "code_information": [{"code": "88387", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 75.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 75.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 78.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 71.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 52.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 22.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 19.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS REGEN EDENT NONRESORB", "code_information": [{"code": "D7957", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 2566.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS REGEN EDENT RESORB", "code_information": [{"code": "D7956", "type": "HCPCS"}], "standard_charges": [{"minimum": 2309.0, "maximum": 2566.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS TRNSGLTMNASE EA IG CLAS", "code_information": [{"code": "86364", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 93.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 187.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 187.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 197.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 177.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 132.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 33.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 28.68, "methodology": "fee schedule"}], 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"type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TITANIUM RIGHT OFFSET HOOK  SMALL 2000-5538", "code_information": [{"code": "2000-5538", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TITANIUM WIDE LAMINAR HOOK  LARGE 14-501161", "code_information": [{"code": "14-501161", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TITANIUM WIDE LAMINAR HOOK  MEDIUM 14-501160", "code_information": [{"code": "14-501160", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TITANIUM WIDE LAMINAR HOOK  SMALL 14-501159", "code_information": [{"code": "14-501159", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TITANIUM WIDE LAMINAR HOOK  SMALL 2000-5518", "code_information": [{"code": "2000-5518", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TL201 THALLIUM", "code_information": [{"code": "A9505", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TLIF MODULUS 8MM X 10MM X 25MM 4DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2080254P2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TLIF-O MODULUS 10MM X 10MM X 25MM 4DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2100254P2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TLIF-O MODULUS 10MM X 10MM X 25MM 8DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "2100258P2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13000.0, "discounted_cash": 7800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TM FEM METAPHYSEAL CONE  35 LARGE  LEFT 00545002235", "code_information": [{"code": "545002235", "type": "CDM"}], "standard_charges": [{"gross_charge": 10780.56, "discounted_cash": 6468.34, "setting": "both", "billing_class": "facility"}]}, {"description": "TM FEM METAPHYSEAL CONE  35 LARGE  RIGHT 00545002236", "code_information": [{"code": "545002236", "type": "CDM"}], "standard_charges": [{"gross_charge": 10780.56, "discounted_cash": 6468.34, "setting": "both", "billing_class": "facility"}]}, {"description": "TM FEM METAPHYSEAL CONE  35 MEDIUM  LEFT 00545002135", "code_information": [{"code": "545002135", "type": "CDM"}], "standard_charges": [{"gross_charge": 10780.56, "discounted_cash": 6468.34, "setting": "both", "billing_class": "facility"}]}, {"description": "TM FEM METAPHYSEAL CONE  35 MEDIUM  RIGHT 00545002136", "code_information": [{"code": "545002136", "type": "CDM"}], "standard_charges": [{"gross_charge": 10780.56, "discounted_cash": 6468.34, "setting": "both", "billing_class": "facility"}]}, {"description": "TM FEM METAPHYSEAL CONE  35 SMALL  LEFT 00545002035", "code_information": [{"code": "545002035", "type": "CDM"}], "standard_charges": [{"gross_charge": 10780.56, "discounted_cash": 6468.34, "setting": "both", "billing_class": "facility"}]}, {"description": "TM FEM METAPHYSEAL CONE  35 SMALL  RIGHT 00545002036", "code_information": [{"code": "545002036", "type": "CDM"}], "standard_charges": [{"gross_charge": 10780.56, "discounted_cash": 6468.34, "setting": "both", "billing_class": "facility"}]}, {"description": "TM REV 10 DEG OBLIQUE LINER LONGEVITY 58X36 00711005836", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "711005836", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5642.0, "discounted_cash": 3385.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TMA/TMAO PRFL MS/MS UR ALG", "code_information": [{"code": "256U", "type": "CPT"}], "standard_charges": [{"minimum": 398.1, "maximum": 468.38, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 468.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 398.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMPST AUTO TUBE DLVR SYS", "code_information": [{"code": "583T", "type": "CPT"}], "standard_charges": [{"minimum": 2585.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMVI PERCUTANEOUS APPROACH", "code_information": [{"code": "483T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMVI TRANSTHORACIC EXPOSURE", "code_information": [{"code": "484T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBE ENDOTRACHEAL MURPHY CUFFED SIZE 8.0", "code_information": [{"code": "M0580C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.99, "discounted_cash": 10.79, "setting": "both", "billing_class": "facility"}]}, {"description": "TOBRADEX 0.1%-0.3% OPTH OINT 3.5GM", "code_information": [{"code": "MED0209", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 514.95, "discounted_cash": 308.97, "setting": "both", "billing_class": "facility"}]}, {"description": "TOBRADEX OPTH 0.1%-0.3% SUSP 2.5 ML", "code_information": [{"code": "MED0208", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 169.54, "discounted_cash": 101.72, "setting": "both", "billing_class": "facility"}]}, {"description": "TOBRAMYCIN (TOBREX) 0.3% OPHTH DROPS 5ML", "code_information": [{"code": "MED0207", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 55.08, "discounted_cash": 33.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TOBRAMYCIN 1.2 gm POWDER", "code_information": [{"code": "MED0206", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 204.66, "discounted_cash": 122.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TOBRAMYCIN 80 MG / 2 ML VIAL", "code_information": [{"code": "MED0375", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.44, "discounted_cash": 6.86, "setting": "both", "billing_class": "facility"}]}, {"description": "TOE GRIP INTERPHALANGEAL DEVICE TGRXS00", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TGRXS00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3380.0, "discounted_cash": 2028.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOE JOINT TRANSFER", "code_information": [{"code": "26556", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOE TAC LARGE HAMMERTOE FIXATION SYSTEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "HT-00003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2238.75, "discounted_cash": 1343.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TOE TAC MEDIUM HAMMERTOE FIXATION SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HT-00002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5912.4, "discounted_cash": 3547.44, "setting": "both", "billing_class": "facility"}]}, {"description": "TOEGRIP RETROGRADE INTERPHALANGEAL DEVICE TGRMM00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TGRMM00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1950.0, "discounted_cash": 1170.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOEGRIP SMALL 0DEG PROX INTER PHALANGEAL ARTH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TGSS00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3380.0, "discounted_cash": 2028.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOGA SURGICAL TOTALSHIELD ZIPPERED LARGE AAMI LEVEL 3", "code_information": [{"code": "990031110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 191.36, "discounted_cash": 114.82, "setting": "both", "billing_class": "facility"}]}, {"description": "TOMOSYNTHESIS, MAMMO", "code_information": [{"code": "G0279", "type": "HCPCS"}], "standard_charges": [{"minimum": 95.0, "maximum": 111.77, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 111.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 95.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONE DECAY HEARING TEST", "code_information": [{"code": "92563", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE AND NECK SURGERY", "code_information": [{"code": "41135", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE BASE VOL REDUCTION", "code_information": [{"code": "41530", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8536.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7255.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE JAW & NECK SURGERY", "code_information": [{"code": "41155", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE MOUTH JAW SURGERY", "code_information": [{"code": "41150", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE MOUTH NECK SURGERY", "code_information": [{"code": "41153", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE REMOVAL NECK SURGERY", "code_information": [{"code": "41145", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE SUSPENSION", "code_information": [{"code": "41512", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE TO LIP SURGERY", "code_information": [{"code": "41510", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": 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"case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL FACIAL NERVE DECOMPRESSION AND OR REPAIR 69955", "code_information": [{"code": "69955", "type": "CPT"}, {"code": "1482255", "type": "CDM"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP RESURFACING", "code_information": [{"code": "S2118", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE POLY XE LFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "M5725060XE10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17738.21, "discounted_cash": 10642.93, "setting": "both", "billing_class": "facility"}]}, {"description": "TOTAL LUNG LAVAGE", "code_information": [{"code": "32997", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"plan_name": "BCBS DFW", "standard_charge_dollar": 107.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 107.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 112.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 101.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER 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"UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOUCH QUANT SENSORY TEST", "code_information": [{"code": "106T", "type": "CPT"}], "standard_charges": [{"minimum": 32.59, "maximum": 68.92, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 32.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 65.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 65.49, "methodology": "fee 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"standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 236.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 474.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 474.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 499.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 449.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 334.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 511.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 435.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPMT NUDT15 GENES", "code_information": [{"code": "34U", "type": "CPT"}], "standard_charges": [{"minimum": 1160.23, "maximum": 1365.06, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1365.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1160.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV ADJMT", "code_information": [{"code": "53454", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV BI", "code_information": [{"code": "53451", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPS CAP ECLIPSE TRUNION 45MM AR-9301-45CPC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9301-45CPC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7800.0, "discounted_cash": 4680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TR RETINAL LES PRETERM INF", "code_information": [{"code": "67229", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRABECULOPLASTY BY LASER SURGERY 65855", "code_information": [{"code": "65855", "type": "CPT"}, {"code": "1482259", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRABECULOSTOMY INT LSR W/SCP", "code_information": [{"code": "622T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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"setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 61200.3, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 36057.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC", "code_information": [{"code": "13", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17076.51, "maximum": 30056.3, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 30056.3, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 17076.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. 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BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRACHEOTOMY TUBE CHANGE PRIOR TO ESTABLISHMENT OF FISTULA TRACT 31502", "code_information": [{"code": "31502", "type": "CPT"}, {"code": "42898074", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1105.0, "maximum": 10356.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRACKER PATIENT AXIEM DISP", "code_information": [{"code": "9733534", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 537.24, "discounted_cash": 322.34, "setting": "both", "billing_class": "facility"}]}, {"description": "TRACKERINSTR AXIEM DISP", "code_information": [{"code": "9733533", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 430.52, "discounted_cash": 258.31, "setting": "both", "billing_class": "facility"}]}, {"description": "TRACPATCH SYSTEM DUO KNEE", "code_information": [{"code": "4000-0-1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1620.0, "discounted_cash": 972.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANEXAMIC ACID 1000MG/10ML", "code_information": [{"code": "MED0287", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 56.63, "discounted_cash": 33.98, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANEXAMIC ACID 100MG/ML IV SOLUTION", "code_information": [{"code": "MED0519", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 34.77, "discounted_cash": 20.86, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSAB ESOPH HIAT HERN RPR", "code_information": [{"code": "43332", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSAB ESOPH HIAT HERN RPR", "code_information": [{"code": "43333", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSABDOM AMNIOINFUS W/US", "code_information": [{"code": "59070", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH CLOSURE OF ASD", "code_information": [{"code": "93580", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 23180.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 13391.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 23180.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH CLOSURE OF VSD", "code_information": [{"code": "93581", "type": "CPT"}], "standard_charges": [{"minimum": 3330.0, "maximum": 23180.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3330.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4892.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6688.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6336.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4717.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA CMC", "standard_charge_dollar": 9849.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 15257.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 8055.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 12969.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 13391.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 23180.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH EMBOLIZ MICROSPHER", "code_information": [{"code": "S2095", "type": "HCPCS"}], "standard_charges": [{"minimum": 3070.0, "maximum": 6491.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH INTRAOP MICROINF", "code_information": [{"code": "C9759", "type": "HCPCS"}], "standard_charges": [{"minimum": 1720.0, "maximum": 4173.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH MTRAL VLVE REPAIR", "code_information": [{"code": "345T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH OCCLUSION CNS", "code_information": [{"code": "61624", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH OCCLUSION NON-CNS", "code_information": [{"code": "61626", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH STENT CCA W/EPS", "code_information": [{"code": "37215", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee 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CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATHETER BIOPSY", "code_information": [{"code": "37200", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCERVICAL INTRO FALLOPIAN TUBE CATH FOR DX OR RE-EST. PATENCY W/ W/O HYSTEROSALPINGOGRAPHY 58345", "code_information": [{"code": "58345", "type": "CPT"}, {"code": "2650539", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCONNECTOR NUT DRIVER 7.5MM 03.614.040", "code_information": [{"code": "3.614.040", "type": "CDM"}], "standard_charges": [{"gross_charge": 2265.84, "discounted_cash": 1359.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSCONNECTOR SPINE SIZE 7 47-64MM SNAP-ON CALIPER TELESCOPING 22DEG ART 15DEG ROT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4.633.347", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSCRV ABLTJ UTRN FIBRD RF", "code_information": [{"code": "58580", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 82.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 82.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 86.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 78.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 86.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 78.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 58.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 27.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 23.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSDERMAL GFR MEASUREMENTS", "code_information": [{"code": "602T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSDUCER BP 84IN MONITOR VAMP SYSTEM ARM MOUNT RESERVOIR", "code_information": [{"code": "PXVMP184", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 431.6, "discounted_cash": 258.96, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSDUCER HOLDER TRUCLIP 2.5LB .5-1.5IN IV POLE TCLIP05", "code_information": [{"code": "TCLIP05", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 379.2, "discounted_cash": 227.52, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSECT 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSECTION OR AVULSION OF OTHER SPINAL NERVE-EXTRADURAL 64772", "code_information": [{"code": "64772", "type": "CPT"}, {"code": "1482263", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", 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{"description": "TRANSECTION OR AVULSION OF VAGUS NERVE-ABDOMINAL 64760", "code_information": [{"code": "64760", "type": "CPT"}, {"code": "1482264", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSECTION OR AVULSION OF VAGUS NERVE-TRANSTHORACIC 64752", "code_information": [{"code": "1482265", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSECTION OR AVULSION OF VAGUS NERVES LIMITED TO PROXIMAL STOMACH 64755", "code_information": [{"code": "64755", "type": "CPT"}, {"code": "1482266", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": 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"standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER  OR TRANSPLANT TENDON-PALMAR; W/O FREE TENDON GRAFT 26485", "code_information": [{"code": "26485", "type": "CPT"}, {"code": "1482275", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF EMBRYO", "code_information": [{"code": "58976", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF ILIOPSOAS MUSCLE", "code_information": [{"code": "27111", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8179.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7361.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPEDICULAR APPR. 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"standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPETROSAL APPROACH/SKULL", "code_information": [{"code": "61598", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPL ALLOGRAFT PANCREAS", "code_information": [{"code": "48554", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT OF THIGH TENDON", "code_information": [{"code": "27396", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT URETER TO SKIN", "code_information": [{"code": "50860", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT/GRAFT PALM TENDON", "code_information": [{"code": "26489", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION HEART/LUNG", "code_information": [{"code": "33935", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF HEART", "code_information": [{"code": "33945", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF KIDNEY", "code_information": [{"code": "50360", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF KIDNEY", "code_information": [{"code": "50365", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF LIVER", "code_information": [{"code": "47135", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": 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"standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF MULTIVISC", "code_information": [{"code": "S2054", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF SMALL INT", "code_information": [{"code": "S2053", "type": "HCPCS"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF 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SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLJ HEMATOPOIETIC BOOST", "code_information": [{"code": "38243", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPORT PORTABLE EKG", "code_information": [{"code": "R0076", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPORT PORTABLE X-RAY", "code_information": [{"code": "R0070", "type": "HCPCS"}], "standard_charges": [{"minimum": 126.48, "maximum": 267.4, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 254.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 254.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 267.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 240.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 179.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPOSITION OF VEIN VALVE", "code_information": [{"code": "34510", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPOSITION; OVARY 58825", "code_information": [{"code": "58825", "type": "CPT"}, {"code": "45517328", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 14275.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTEMPORAL APPROACH/SKULL", "code_information": [{"code": "61595", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR DIAPHRAG HERN RPR", "code_information": [{"code": "43335", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": 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"plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSURETHERAL RESECTION RESIDUAL/REGROWTH OBSTRUCTIVE PROSTATE TISSUE INC POST OP BLEED 52630", "code_information": [{"code": "52630", "type": "CPT"}, {"code": "35197598", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 10356.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL DESTRUCTION PROSTATE BY RADIOFREQUENCY 53852", "code_information": [{"code": "53852", "type": "CPT"}, {"code": "1482284", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL INCISION OF PROSTATE 52450", "code_information": [{"code": "52450", "type": "CPT"}, {"code": "1646740", "type": "CDM"}, 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{"description": "TRAY TIBIAL G2 IUNI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "UKA1111111-TT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2062.5, "discounted_cash": 1237.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBIAL INFINITY ADAPTIS 33680001 33680001", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "33680001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8437.0, "discounted_cash": 5062.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBIAL INFINITY ANKLE SZ 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "33650002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12999.0, "discounted_cash": 7799.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBIAL IUNI G2 CUSTOM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "UKA111111-TT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2062.5, "discounted_cash": 1237.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBIAL MEDACTA SZ5 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "2.07.1205R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5137.6, "discounted_cash": 3082.56, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBIAL MEDIAL CO-CR-MO CEMENTED RIGHT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "154727", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6453.2, "discounted_cash": 3871.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBIAL MODULAR SLOPED SZ 3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "562-2300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7098.88, "discounted_cash": 4259.33, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBIAL NONPOROUS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "162-1200A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2380.0, "discounted_cash": 1428.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBIAL NONPOROUS SZ5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "162-1500A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4420.0, "discounted_cash": 2652.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBIAL REVISION MBT CEMENTED SIZE 2.5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1294-35-125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10273.9, "discounted_cash": 6164.34, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBIAL REVISION MBT CEMENTED SIZE 3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1294-35-130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10274.0, "discounted_cash": 6164.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBL 67MM OFFSET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "141482", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8424.0, "discounted_cash": 5054.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBL 67MM STEMINTERLOK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "141512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9094.8, "discounted_cash": 5456.88, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBL 79MM CRUCIATE FINNED ASCENT MAXIM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "141235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4019.6, "discounted_cash": 2411.76, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBL 79MM VANGUARD 360", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "185205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9094.8, "discounted_cash": 5456.88, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBL SZ 2 RIGHT MEDIAL LFT LAT ZIK HIGH FLEX PRECOAT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "-5842-002-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3980.73, "discounted_cash": 2388.44, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBL SZ 3 15MM MOBILE BEARING REV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "129435315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14136.0, "discounted_cash": 8481.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBL SZ 3 LFT MEDIAL IBALANCE UKA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-501-TTLC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6687.2, "discounted_cash": 4012.32, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBL SZ 4 CEMENTED MBT REV IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1294-35-140", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17082.0, "discounted_cash": 10249.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBL SZ 5 RIGHT MEDIAL IBALANCE UKA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-501-TTRE", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY TIBL SZ 6 CEMENTED MOBILE BEARING REV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "129435160", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15784.83, "discounted_cash": 9470.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY iTOTAL TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "TPS-111-1111-TT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAYINCISION DRAINAGE STRL", "code_information": [{"code": "DYNJ07900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.03, "discounted_cash": 8.42, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAYINSTR HIP UC", "code_information": [{"code": "72203727", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 319.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAYINSTRATION ROTATOR CUFF", "code_information": [{"code": "72203730", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 931.0, "discounted_cash": 558.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAYS WET PREMIUM SKIN SCRUB  DYND70660", "code_information": [{"code": "DYND70660", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.32, "discounted_cash": 15.19, "setting": "both", "billing_class": "facility"}]}, {"description": "TRB@ GENE REARRANGE DIRPROBE", "code_information": [{"code": "81341", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 145.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 123.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRCATH REPLACE AORTIC VALVE", "code_information": [{"code": "33366", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27840", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28490", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28495", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT CHEST LINING", "code_information": [{"code": "32215", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21431", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21432", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21433", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21435", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21436", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT EACH ADD SPINE FX", "code_information": [{"code": "22328", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59121", "type": "CPT"}], "standard_charges": [{"minimum": 3094.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59130", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59136", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59140", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24587", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26755", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28540", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28545", "type": "CPT"}], "standard_charges": [{"minimum": 1887.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28575", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28600", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28605", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25520", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS & ULNA", "code_information": [{"code": "25560", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26670", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27252", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27253", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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"standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27254", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27256", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27257", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27258", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27259", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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[{"code": "27265", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP FRACTURE(S)", "code_information": [{"code": "27227", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP FRACTURE(S)", "code_information": [{"code": "27228", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP SOCKET FRACTURE", "code_information": [{"code": "27220", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP SOCKET FRACTURE", "code_information": [{"code": "27222", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP WALL FRACTURE", "code_information": [{"code": "27226", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24530", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24560", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24565", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24576", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24577", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27550", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27552", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27556", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27557", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27558", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27560", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27562", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27566", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP FRACTURE", "code_information": [{"code": "27520", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21450", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21452", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27830", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee 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"plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27831", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27832", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27826", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28470", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE EACH", "code_information": [{"code": "28455", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21421", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 9519.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT NECK SPINE FRACTURE", "code_information": [{"code": "22326", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ODONTOID FX W/GRAFT", "code_information": [{"code": "22319", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ODONTOID FX W/O GRAFT", "code_information": [{"code": "22318", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27216", "type": "CPT"}], "standard_charges": [{"minimum": 3344.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27218", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT PENIS LESION GRAFT", "code_information": [{"code": "54111", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT PENIS LESION GRAFT", "code_information": [{"code": "54112", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT PLEURODESIS W/AGENT", "code_information": [{"code": "32560", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SESAMOID BONE FRACTURE", "code_information": [{"code": "28530", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SKULL FRACTURE", "code_information": [{"code": "62000", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SKULL FRACTURE", "code_information": [{"code": "62005", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27175", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27177", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27178", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT STERNUM FRACTURE", "code_information": [{"code": "21820", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT STERNUM FRACTURE", "code_information": [{"code": "21825", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TAIL BONE FRACTURE", "code_information": [{"code": "27200", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": 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"plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TAIL BONE FRACTURE", "code_information": [{"code": "27202", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27230", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee 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"plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27232", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27236", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27238", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27240", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27244", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27246", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FX GROWTH PLATE", "code_information": [{"code": "27517", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THORAX SPINE FRACTURE", "code_information": [{"code": "22327", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB FRACTURE", "code_information": [{"code": "26645", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28630", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28635", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF 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charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 5831.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 4956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ULNAR FRACTURE", "code_information": [{"code": "24675", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT UTERUS INFECTION", "code_information": [{"code": "59830", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT VAGINA INFECTION", "code_information": [{"code": "57150", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT VAGINAL BLEEDING", "code_information": [{"code": "57180", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25622", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25630", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25660", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT HUMERAL SHAFT FRACTURE W/ INTRAMEDULLARY IMPLANT 24516", "code_information": [{"code": "24516", "type": "CPT"}, {"code": "1481739", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8945.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANAL FISSURE", "code_information": [{"code": "46940", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27816", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "28435", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF EXTENSIVE OR PROGRESSIVE RETINOPATHY 1 OR MORE SESSION PHOTOCOAGULATION 67228", "code_information": [{"code": "67228", "type": "CPT"}, {"code": "14100560", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEEL FRACTURE", "code_information": [{"code": "28405", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF INTERO/PERI/SUBTROCHANTERIC FEMORAL FX W/INTRAMEDULLARY IMPLANT W OR W/O SCREW 27245", "code_information": [{"code": "27245", "type": "CPT"}, {"code": "8480325", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 14483.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RIB FRACTURE", "code_information": [{"code": "21812", "type": "CPT"}], "standard_charges": [{"minimum": 2481.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee 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"standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27501", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE 27507", "code_information": [{"code": "27507", "type": "CPT"}, {"code": "43009975", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", 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"standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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1219.48, "discounted_cash": 731.69, "setting": "both", "billing_class": "facility"}]}, {"description": "TREPHINE 6279141 PSR 14X11 6279141", "code_information": [{"code": "6279141", "type": "CDM"}], "standard_charges": [{"gross_charge": 1219.48, "discounted_cash": 731.69, "setting": "both", "billing_class": "facility"}]}, {"description": "TREPHINE 6279144 PSR 14X14 6279144", "code_information": [{"code": "6279144", "type": "CDM"}], "standard_charges": [{"gross_charge": 1219.48, "discounted_cash": 731.69, "setting": "both", "billing_class": "facility"}]}, {"description": "TREPHINE 7570802 REDUX SUCTION 7570802", "code_information": [{"code": "7570802", "type": "CDM"}], "standard_charges": [{"gross_charge": 737.35, "discounted_cash": 442.41, "setting": "both", "billing_class": "facility"}]}, {"description": "TREPHINE 900-030 6MM 900-030", "code_information": [{"code": "900-030", "type": "CDM"}], "standard_charges": [{"gross_charge": 1234.51, "discounted_cash": 740.71, "setting": "both", 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"standard_charges": [{"gross_charge": 634.41, "discounted_cash": 380.65, "setting": "both", "billing_class": "facility"}]}, {"description": "TREPHINE CENTERING PIN 387.633", "code_information": [{"code": "387.633", "type": "CDM"}], "standard_charges": [{"gross_charge": 1434.24, "discounted_cash": 860.54, "setting": "both", "billing_class": "facility"}]}, {"description": "TREPHINE PUSHER 387.634", "code_information": [{"code": "387.634", "type": "CDM"}], "standard_charges": [{"gross_charge": 1244.88, "discounted_cash": 746.93, "setting": "both", "billing_class": "facility"}]}, {"description": "TREPHINE VACUUM 7.50MM CORNEAL HESSBURG-BARRON", "code_information": [{"code": "21-8275", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 271.76, "discounted_cash": 163.06, "setting": "both", "billing_class": "facility"}]}, {"description": "TREPHINE VACUUM 7.75MM CORNEAL HESSBURG-BARRON", "code_information": [{"code": "21-8277", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 271.76, "discounted_cash": 163.06, "setting": "both", "billing_class": "facility"}]}, {"description": "TREPHINE VACUUM 8.00MM CORNEAL HESSBURG-BARRON", "code_information": [{"code": "21-8280", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 271.76, "discounted_cash": 163.06, "setting": "both", "billing_class": "facility"}]}, {"description": "TREPHINE VACUUM 8.25MM CORNEAL HESSBURG-BARRON", "code_information": [{"code": "21-8282", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 271.76, "discounted_cash": 163.06, "setting": "both", "billing_class": "facility"}]}, {"description": "TREPHINE VACUUM 8.50MM CORNEAL HESSBURG-BARRON", "code_information": [{"code": "21-8285", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 271.76, "discounted_cash": 163.06, "setting": "both", "billing_class": "facility"}]}, {"description": "TREPHINE VACUUM 9.00MM CORNEAL HESSBURG-BARRON", "code_information": [{"code": "21-8290", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 271.76, "discounted_cash": 163.06, "setting": "both", "billing_class": "facility"}]}, {"description": "TREPONEMA PALLIDUM AG IF", "code_information": [{"code": "87285", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 186.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 139.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 35.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 30.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRETINOIN TOPICAL 5 G", "code_information": [{"code": "S0117", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", 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"standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 43.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 86.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 86.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 91.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 82.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 61.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 58.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 49.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRICYCLIC & CYCLICALS 6/MORE", "code_information": [{"code": "80337", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 9.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 18.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 19.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 13.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIESENCE (TRIAMCINOLONE) 40MG/ML PF", "code_information": [{"code": "MED0523", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 25.5, "discounted_cash": 15.3, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIGGER FLEX PROBE DTF-38", "code_information": [{"code": "DTF-38", "type": "CDM"}], "standard_charges": [{"gross_charge": 957.6, "discounted_cash": 574.56, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIM NAIL(S)", "code_information": [{"code": "G0127", "type": "HCPCS"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIM NAIL(S) ANY NUMBER", "code_information": [{"code": "11719", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRINITY ELITE 5CC MED", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "410002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5252.0, "discounted_cash": 3151.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TRINITY ELITE EXTRA LARGE", "code_information": [{"code": "C1734", "type": "HCPCS"}, {"code": "410004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13880.0, "discounted_cash": 8328.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRINITY ELITE LARGE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "410003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9477.0, "discounted_cash": 5686.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TRINITY ELITE SMALL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "410001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1365.0, "discounted_cash": 819.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIPLANE BK5000 9018 762", "code_information": [{"code": "762", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4704.48, "discounted_cash": 2822.69, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIPLE-EDGE RELEASE INSTRUMENT SN21", "code_information": [{"code": "SN21", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 931.0, "discounted_cash": 558.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIPLEDAM CANNULA 7MM X 7CM VALVED", "code_information": [{"code": "AR-6570TD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.06, "discounted_cash": 101.44, "setting": "both", "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP 1ST ART", "code_information": [{"code": "37246", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP 1ST VEIN", "code_information": [{"code": "37248", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP ADDL ART", "code_information": [{"code": "37247", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP ADDL VEIN", "code_information": [{"code": "37249", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML DIL AQ O/F CAN W/ST", "code_information": [{"code": "66175", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 7055.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5997.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC ABD AORTA", "code_information": [{"code": "236T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC BRCHIOCPH", "code_information": [{"code": "237T", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC ILIAC ART", "code_information": [{"code": "238T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC RENAL ART", "code_information": [{"code": "234T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC VISCERAL", "code_information": [{"code": "235T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSCTH RENAL SYMP DENRV BIL", "code_information": [{"code": "339T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSCTH RENAL SYMP DENRV UNL", "code_information": [{"code": "338T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4502.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 6615.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9043.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 9519.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 8567.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6378.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ DON-DRV CLL-FR DNA", "code_information": [{"code": "118U", "type": "CPT"}], "standard_charges": [{"minimum": 6852.42, "maximum": 8062.19, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 8062.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 6852.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ KDN ALGRFT REJ 1494", "code_information": [{"code": "88U", "type": "CPT"}], "standard_charges": [{"minimum": 7863.31, "maximum": 9251.56, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 9251.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 7863.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ PD LVR&BWL CD154+CLL", "code_information": [{"code": "81560", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1876.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1594.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ RNL MEAS CD154+CLL", "code_information": [{"code": "18M", "type": "CPT"}], "standard_charges": [{"minimum": 1594.66, "maximum": 1876.2, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1876.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1594.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSXJ/REPOS ABRRNT RNL VSLS", "code_information": [{"code": "50100", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TROACR CANNULA EDGEPLUS VALVED ENTRY SYSTEM 4MM 23G 8065751585", "code_information": [{"code": "8065751585", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.25, "discounted_cash": 99.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR 12MM BALLOON", "code_information": [{"code": "CFR73", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.52, "discounted_cash": 54.91, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR 5MMX100MM CANN/SEAL", "code_information": [{"code": "CTS02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 128.54, "discounted_cash": 77.12, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR 5X150 SMOOTH -ORDR QTY 6 2B5XT", "code_information": [{"code": "2B5XT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 506.78, "discounted_cash": 304.07, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR 7578015 50MM PERC PEEK TROCAR 7578015", "code_information": [{"code": "7578015", "type": "CDM"}], "standard_charges": [{"gross_charge": 414.69, "discounted_cash": 248.81, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR 7578019 90MM PERC PEEK TROCAR 7578019", "code_information": [{"code": "7578019", "type": "CDM"}], "standard_charges": [{"gross_charge": 414.69, "discounted_cash": 248.81, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR AIRSEAL 5 X 120MM LAP OBTURATOR LOW PRO BLADELESS OPTICAL TIP", "code_information": [{"code": "IAS5-120LP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 255.49, "discounted_cash": 153.29, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS 12MM 100MM ENDOPATH XCEL", "code_information": [{"code": "B12LP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.17, "discounted_cash": 56.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS 12MM 15OMM ENDOPATH XCEL", "code_information": [{"code": "B12XT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 158.87, "discounted_cash": 95.32, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS 15MM X 100MM STABILITY SLEEVE REPROCESS ENDOPATH XCEL", "code_information": [{"code": "B15LTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 163.53, "discounted_cash": 98.12, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS 5 MM TO 12 MM W/ FXTN CANNULA", "code_information": [{"code": "NB15STF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 293.49, "discounted_cash": 176.09, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS 5MM X 150MM LAP OPTIC TIP ENDOPATH XCEL", "code_information": [{"code": "ETHB5XT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.55, "discounted_cash": 96.93, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS 5MM X 75MM STABILITY SLEEVE REPROCESS ENDOPATH XCEL", "code_information": [{"code": "B5STR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 267.54, "discounted_cash": 160.52, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS ENDOPATH XCEL 3 NEW & 3 REPROCESSED 12 X 100MM", "code_information": [{"code": "SUSB12LT33", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.14, "discounted_cash": 46.28, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS ENDOPATH XCEL 3 NEW & 3 REPROCESSED 5 X 100MM", "code_information": [{"code": "SUSB5LT33", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.31, "discounted_cash": 45.79, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS ENDOPATH XCEL 4 NEW & 2 REPROCESSED 12 X 100MM", "code_information": [{"code": "SUSB12LT42", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.14, "discounted_cash": 46.28, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS ENDOPATH XCEL 4 NEW & 2 REPROCESSED 5 X 100MM", "code_information": [{"code": "SUSB5LT42", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.14, "discounted_cash": 46.28, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESS OBTUR OPTICAL 12/100MM B12LT", "code_information": [{"code": "B12LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.46, "discounted_cash": 63.28, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLADELESSS 8MM X 100MM STABILITY SLEEVE LAP BLUNT REPROCESS ENDOPATH XCEL", "code_information": [{"code": "B8LTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 125.38, "discounted_cash": 75.23, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR BLUNT TIP XCEL 12X100MM RPR H12LP", "code_information": [{"code": "H12LP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.03, "discounted_cash": 63.02, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR DIALATING TIP STABILITY SLV 5/100 D5LT", "code_information": [{"code": "D5LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 403.61, "discounted_cash": 242.17, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR DILATING TIP STABILITY SLV 5X75 D5ST", "code_information": [{"code": "D5ST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.28, "discounted_cash": 57.17, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR DILATING TIP STABLE SLV 12X100MM D12LT", "code_information": [{"code": "D12LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 449.67, "discounted_cash": 269.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO 15MM VERSAPORT PLUS RPF FIXATION CANNULA", "code_information": [{"code": "179078PF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 230.2, "discounted_cash": 138.12, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO 5 TO 12MM VISIPORT PLUS VERSAPORT FIXATION CANNULA", "code_information": [{"code": "176674PF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.89, "discounted_cash": 207.53, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO 5MM VERSAPORT BLADELESS LOW PRO", "code_information": [{"code": "NB5STFLP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.6, "discounted_cash": 35.16, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO 5MM X 100MM RESPOSABLE DILATING TIP OBTURATOR AND HOUSING ENDOPATH", "code_information": [{"code": "35LDA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 274.91, "discounted_cash": 164.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO KII 12 X 100MM ACCESS SYSTEM SHIELDED BLADED ADVANCED FIXATION", "code_information": [{"code": "CFB73", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.28, "discounted_cash": 29.57, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO KII 5 X 100MM ACCESS SYSTEM ADVANCED FIXATION SLEEVE SHIELDED BLADED", "code_information": [{"code": "CFB03", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.4, "discounted_cash": 46.44, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO XCEL BLADELESS 15MM 100MM B15LT", "code_information": [{"code": "B15LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.81, "discounted_cash": 100.09, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO XCEL BLDLS 11MM STRL NO HNDL B11LT", "code_information": [{"code": "B11LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.46, "discounted_cash": 63.28, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDOPATH XCEL BLADELESS 11MM B11LP", "code_information": [{"code": "B11LP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 449.26, "discounted_cash": 269.56, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDOSCOPY KII ACCESS SYSTEM LATEX FREE SHIELDED BLADED 12 X 100MM", "code_information": [{"code": "CTB73", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 227.84, "discounted_cash": 136.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR FOR CANNULATED AWL/PROBES 03.616.062", "code_information": [{"code": "3.616.062", "type": "CDM"}], "standard_charges": [{"gross_charge": 1173.06, "discounted_cash": 703.84, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR FOR CANNULATED AWLS 03.606.020", "code_information": [{"code": "3.606.020", "type": "CDM"}], "standard_charges": [{"gross_charge": 406.98, "discounted_cash": 244.19, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR FOR SACRAL SOUNDER 388.497", "code_information": [{"code": "388.497", "type": "CDM"}], "standard_charges": [{"gross_charge": 688.94, "discounted_cash": 413.36, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR HERNIA BALLOON BLUNT TIP 12 MM OMS-T12BT", "code_information": [{"code": "OMS-T12BT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 436.49, "discounted_cash": 261.89, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR HERNIA BALLOON BLUNT TIP 12 MM OMST12BT", "code_information": [{"code": "OMST12BT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 221.2, "discounted_cash": 132.72, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR KII FIOS 12MM X 100MM", "code_information": [{"code": "CFF73", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.52, "discounted_cash": 54.91, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR KII FIOS ADV FIX 5MM X 100MM", "code_information": [{"code": "CFF03", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 174.72, "discounted_cash": 104.83, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR LAP 100MM 5 NN BLADELESS REPROCESS VERSASTEP PLUSINSTR", "code_information": [{"code": "VS101005R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 155.63, "discounted_cash": 93.38, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR LAP 11MM 100MM BLADELESS OPTIC TIP STABILITY SLEEVE ENDOPATH XCEL LF STRL", "code_information": [{"code": "ETHB11LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.46, "discounted_cash": 63.28, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR LAP 12MM X 100MM BLADELESS REPROCESS W/ STABILITY SLEEVE ENDOPATH XCEL", "code_information": [{"code": "B12LTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.72, "discounted_cash": 52.63, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR LAP 5MM X 100MM DILATING TIP STABILITY SLEEVE OBTURATOR REPROCESS ENDOPAT", "code_information": [{"code": "D5LTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.17, "discounted_cash": 56.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR LAP KII 100 X 11MM ACCESS FIRST ENTRY ADVANCED FIXATION", "code_information": [{"code": "CFF33", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 227.84, "discounted_cash": 136.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR NO BLADE 5MM SHORT FIX NONB5SHF", "code_information": [{"code": "NONB5SHF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 143.73, "discounted_cash": 86.24, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR OPTICAL 12MM X 150MM Z THREAD", "code_information": [{"code": "CTF71", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 227.84, "discounted_cash": 136.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR PIN 3/16 X 8 CM 71931993", "code_information": [{"code": "71931993", "type": "CDM"}], "standard_charges": [{"gross_charge": 268.6, "discounted_cash": 161.16, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SLEEVE 12MM XCEL", "code_information": [{"code": "2CB12LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 298.11, "discounted_cash": 178.87, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR STANDARD 11 MM ONB11STF", "code_information": [{"code": "ONB11STF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 271.85, "discounted_cash": 163.11, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 10MM HERNIA BLLN BLUNT TIP", "code_information": [{"code": "OMST10BT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 413.09, "discounted_cash": 247.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 10MM TO 15MM X 5MM TO 12MM W/ 100 MM RADIOLUCENT SLEEVE VERSAPORT PL", "code_information": [{"code": "179078P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 373.09, "discounted_cash": 223.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 11MM BLADELESS REPROCESS ENDOPATH EXCEL STRLINSTR", "code_information": [{"code": "B11LTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.24, "discounted_cash": 48.14, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 11MM X 100MM DILATING TIP STABLE SLEEVE REPROCESS", "code_information": [{"code": "D11LTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.57, "discounted_cash": 50.74, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 12MM X 100MM BLUNT TIP REPROCESS EXCELINSTR", "code_information": [{"code": "H12LPR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.24, "discounted_cash": 48.14, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 5MM TO 12MM W/ ANCHORING DEV BLUNTPORT PLUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "176626P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 363.05, "discounted_cash": 217.83, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SURG 5MM X 100MM BLADELESS STABILITY SLEEVE REPROCESS EXCELINSTR", "code_information": [{"code": "B5LTR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.24, "discounted_cash": 48.14, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR THORACIC CATH 32FR X 20 INCH L", "code_information": [{"code": "570556", "type": "CDM"}], "standard_charges": [{"gross_charge": 77.66, "discounted_cash": 46.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR TIP 10.0MM X 12.0MM DIALATING", "code_information": [{"code": "512XD", "type": "CDM"}], "standard_charges": [{"gross_charge": 200.79, "discounted_cash": 120.47, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR TIP STAINLESS STEEL GUIDEWIRE 320MM 113-320-11", "code_information": [{"code": "113-320-11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.4, "discounted_cash": 99.84, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR VERSAONE 12MM STD OPTICAL ONB12STF", "code_information": [{"code": "ONB12STF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.7, "discounted_cash": 143.82, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR VERSAONE 12MM UNIVERSAL STD UNVCA12STF", "code_information": [{"code": "UNVCA12STF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 151.56, "discounted_cash": 90.94, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR VERSAONE 5MM SHORT BLADED B5SHF", "code_information": [{"code": "B5SHF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.17, "discounted_cash": 56.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR VERSAONE 5MM STD OPTICAL ONB5STF", "code_information": [{"code": "ONB5STF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 181.1, "discounted_cash": 108.66, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR VERSAONE 5MM UNIVERSAL SHORT UNVCA5SHF", "code_information": [{"code": "UNVCA5SHF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.73, "discounted_cash": 81.44, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR VERSAONE 5MM UNIVERSAL STD UNVCA5STF", "code_information": [{"code": "UNVCA5STF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.73, "discounted_cash": 81.44, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR VERSONE 5MM STD BLADED B5STF", "code_information": [{"code": "B5STF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.77, "discounted_cash": 197.86, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR WIRE  BLUNT CS 3821-02", "code_information": [{"code": "CS 3821-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.4, "discounted_cash": 99.84, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR WIRE CS 3821-01", "code_information": [{"code": "CS 3821-01", "type": "CDM"}], "standard_charges": [{"gross_charge": 166.4, "discounted_cash": 99.84, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR XCEL 5MMX75MM -ORDR QTY 6 2B5ST", "code_information": [{"code": "2B5ST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 456.11, "discounted_cash": 273.67, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR XCEL BLADELESS STABLE SLV 5/100MM B5LT", "code_information": [{"code": "B5LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.46, "discounted_cash": 63.28, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR XCEL BLADELESS STABLE SLV 5/150MM B5XT", "code_information": [{"code": "B5XT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 124.3, "discounted_cash": 74.58, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR XCEL BLADELESS STABLE SLV 5/75MM B5ST", "code_information": [{"code": "B5ST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 407.57, "discounted_cash": 244.54, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR XCEL BLADELESS STABLE SLV 8/100MM B8LT", "code_information": [{"code": "B8LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 124.3, "discounted_cash": 74.58, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR XCEL BLUNT TIP 12MMX100MM 2H12LP", "code_information": [{"code": "2H12LP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 537.79, "discounted_cash": 322.67, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR XCEL W OPTIVIEW BLADELESS 5/100MM 2B5LT", "code_information": [{"code": "2B5LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 447.34, "discounted_cash": 268.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCHAR SHIM INTECH SYSTEM", "code_information": [{"code": "LB-120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1728.0, "discounted_cash": 1036.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TRUCLEAR ULTRA  RECIPROCATING MORC. 4.0 72203012", "code_information": [{"code": "72203012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1529.5, "discounted_cash": 917.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TRURL ABLTJ MAL PRST8 TISS", "code_information": [{"code": "582T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRURL DSTRJ PRST8 TISS RF WV", "code_information": [{"code": "53854", "type": "CPT"}], "standard_charges": [{"minimum": 3866.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRUSS SYSTEM 26 X 9MM 6DEG 8MM POST SPINE STRT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PSTS-SM0608-26-SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10400.0, "discounted_cash": 6240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRYPAN BLUE 0.06% (VISION BLUE) OPHTHALMIC SOLUTION 0.5ML", "code_information": [{"code": "MED0212", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 180.94, "discounted_cash": 108.56, "setting": "both", "billing_class": "facility"}]}, {"description": "TSH w/ Rflx Free T4", "code_information": [{"code": "84443", "type": "CPT"}, {"code": "37936366", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "gross_charge": 200.0, "discounted_cash": 120.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 86.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 174.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 174.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 183.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 164.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 122.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 49.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 41.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TSTAG18 / IDENT-ALERT MESSAGE TAG \"EQUIPMENT STATUS\" 8 1/2\" X 2 1/2\" RED YELLOW GREEN", "code_information": [{"code": "TSTAG18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.05, "discounted_cash": 0.63, "setting": "both", "billing_class": "facility"}]}, {"description": "TSUCTION UBE PROFESS CVD 90DEG STRT", "code_information": [{"code": "6001-410-090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 706.58, "discounted_cash": 423.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TTE F-UP OR LMTD", "code_information": [{"code": "93308", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W/DOPPLER COMPLETE", "code_information": [{"code": "93306", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W/O DOPPLER COMPLETE", "code_information": [{"code": "93307", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTVI/RPLCMT W/PRSTC VLV PERQ", "code_information": [{"code": "646T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTVR PERQ APPR 1ST PROSTH", "code_information": [{"code": "569T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTVR PERQ EA ADDL PROSTH", "code_information": [{"code": "570T", "type": "CPT"}], "standard_charges": [{"minimum": 2309.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUBE 4.0 MM HVLP CUFFED ORAL / NASAL ENDOTRACHEAL WITH MURPHY EYE AND BULL-NOSE TIP DYNJAETC40", "code_information": [{"code": "DYNJAETC40", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.32, "discounted_cash": 5.59, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE 4.5MM ENDOTRACHEAL ORAL CUFF PREFORMED", "code_information": [{"code": "5-22209", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.06, "discounted_cash": 28.24, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE 4.5MM TRACH MURPHY", "code_information": [{"code": "86237", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.78, "discounted_cash": 4.07, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE 6.0 MM HVLP CUFFED ORAL / NASAL ENDOTRACHEAL WITH MURPHY EYE AND BULL-NOSE TIP DYNJAETC60", "code_information": [{"code": "DYNJAETC60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.1, "discounted_cash": 4.26, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE 7.6MM CUF LP FEN CANN SHLY TRCH 8 LF DISP", "code_information": [{"code": "MLK8DFEN", "type": "CDM"}], "standard_charges": [{"gross_charge": 168.98, "discounted_cash": 101.39, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE 8360203 FLUSH CUTTING OUTER 8360203", "code_information": [{"code": "8360203", "type": "CDM"}], "standard_charges": [{"gross_charge": 1282.76, "discounted_cash": 769.66, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE 8360204 NON-FLUSH CUTTING OUTER 8360204", "code_information": [{"code": "8360204", "type": "CDM"}], "standard_charges": [{"gross_charge": 1282.76, "discounted_cash": 769.66, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE 945RMA1016 REPLACEMENT 945RMA1016", "code_information": [{"code": "945RMA1016", "type": "CDM"}], "standard_charges": [{"gross_charge": 41.58, "discounted_cash": 24.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE 9569683 COATED/ANGLED 18MMX6CM 9569683", "code_information": [{"code": "9569683", "type": "CDM"}], "standard_charges": [{"gross_charge": 949.62, "discounted_cash": 569.77, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE 9569817 DISP 18MM X 7CM ANGLED 9569817", "code_information": [{"code": "9569817", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 422.67, "discounted_cash": 253.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE APPLICATOR VISTASEAL LAPAROSCOPIC DUAL VSTL35", "code_information": [{"code": "VSTL35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.45, "discounted_cash": 102.27, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ASPIR LUK 6 1/4 8886864604", "code_information": [{"code": "8886864604", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.2, "discounted_cash": 25.32, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ASSYVENAFLOW ELITEXL 3008XL", "code_information": [{"code": "3008XL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 154.25, "discounted_cash": 92.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE CLIP CLOSED GAMMA 3 OSTEO KEIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1320-0125S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 495.9, "discounted_cash": 297.54, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE COMBITUBE  37FR AIRWAY ADLT", "code_information": [{"code": "5-18437 (D)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 15.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE CONNECTING PIGTAIL NEPHROSTOMY URETERAL 30CM", "code_information": [{"code": "G14119", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.12, "discounted_cash": 56.47, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE CONNECTOR MAXILLO FACIAL ENDOTRACHEAL NASAL STANDARD 6.5 MM 100/133/065", "code_information": [{"code": "100/133/065", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.65, "discounted_cash": 27.39, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE CONNECTOR MAXILLO FACIAL ENDOTRACHEAL NASAL STANDARD 7 MM 100/133/070", "code_information": [{"code": "100/133/070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.54, "discounted_cash": 26.72, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE EMG NIM SZ6", "code_information": [{"code": "8229736", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 834.71, "discounted_cash": 500.83, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 3MM UNCUFFED ORAL RAE", "code_information": [{"code": "86263", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.41, "discounted_cash": 8.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4.0MM LASER-SHIELD II LF", "code_information": [{"code": "7060100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 404.54, "discounted_cash": 242.72, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4.5MM LASER-SHIELD II LF", "code_information": [{"code": "7060150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 430.3, "discounted_cash": 258.18, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4.5MM MURPHY LO PRO", "code_information": [{"code": "86046", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.25, "discounted_cash": 4.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4.5MM NASAL ORAL 2 HIGH VOLUME LOW PRESSURE CUFFS MAGILL CURVE MURPHY", "code_information": [{"code": "86397", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 161.4, "discounted_cash": 96.84, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4.5MM RAY MURPHY ORAL PREFORMED CUFFED", "code_information": [{"code": "86199", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.93, "discounted_cash": 14.36, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4.5MM UNCUFFED ORAL RAE", "code_information": [{"code": "86266", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.34, "discounted_cash": 8.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4MM CLR NASAL ORAL UNCUFFED MAGILL CURVE LF STRL PEDI", "code_information": [{"code": "86464", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.61, "discounted_cash": 3.37, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4MM MURPHY LO PRO", "code_information": [{"code": "86045", "type": "CDM"}, {"code": "272", 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{"description": "TWO TONE BONDED WRAP LIGHTWEIGHT 15 X 15 GEM1115T", "code_information": [{"code": "GEM1115T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.49, "discounted_cash": 0.29, "setting": "both", "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS 5.1-10CC", "code_information": [{"code": "11952", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No 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"payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": 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"standard_charges": [{"minimum": 1536.15, "maximum": 8536.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3869.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5684.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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{"description": "UMBILECTOMY 49250", "code_information": [{"code": "49250", "type": "CPT"}, {"code": "1482310", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1536.15, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4545.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6214.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6541.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4382.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6414.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5452.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UMBILICAL ARTERY ECHO", "code_information": [{"code": "76820", "type": "CPT"}], "standard_charges": [{"minimum": 323.79, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 323.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 650.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 650.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 684.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 616.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 458.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UMBILICAL CORD OCCLUD W/US", "code_information": [{"code": "59072", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNCOMPLICATED PEPTIC ULCER WITH MCC", "code_information": [{"code": "383", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9916.34, "maximum": 14338.56, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 14338.56, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9916.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNCOMPLICATED PEPTIC ULCER WITHOUT MCC", "code_information": [{"code": "384", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6277.9, "maximum": 9863.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9863.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 6277.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNDERGLOVE SURG BIOGEL PI INDICATOR 41655", "code_information": [{"code": "41655", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.99, "discounted_cash": 4.79, "setting": "both", "billing_class": "facility"}]}, {"description": "UNICORTICAL BLOCK 8 X 12MM D08582", "code_information": [{"code": "D08582", "type": "CDM"}], "standard_charges": [{"gross_charge": 2376.0, "discounted_cash": 1425.6, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIT LOADING SZ 2-0 SZ 3 7IN GRN SNGL STITCH SURGIDAC SUT ENDO STITCH", "code_information": [{"code": "173021", "type": "CDM"}], "standard_charges": [{"gross_charge": 164.54, "discounted_cash": 98.72, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIT LTHTRP 2 ULTSNC PRB BLDR ST CYBERWAND RNL STRL DISP", "code_information": [{"code": "CW-RBPBX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1121.04, "discounted_cash": 672.62, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIT RLD SUT ENDO DEV W/ 6IN ETHIBOND EXCEL SZ 2-0 AND EEN CANOE NDL", "code_information": [{"code": "SW112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.33, "discounted_cash": 51.8, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERS REVERS CUP, 36/ +2MM RT OFFSET CAP COATED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9502-36RCPC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1915.5, "discounted_cash": 1149.3, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERS REVERS CUP, 39/ NEUTRAL CAP COATED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9502-39CPC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6630.0, "discounted_cash": 3978.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERS REVERS GLENO 39 +4 LAT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9504M-04", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7800.0, "discounted_cash": 4680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERS REVERS HUMERAL STEM SIZE 6 AR-9501-06P", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9501-06P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2434.6, "discounted_cash": 1460.76, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERS REVERS SPACER 36+12MM AR-9555-12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9555-12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1029.0, "discounted_cash": 617.4, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERS REVERS SUTURE CUP 39 (+2 RIGHT)", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9502F-39RCPC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3320.2, "discounted_cash": 1992.12, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERSAL ARM 03.809.941", "code_information": [{"code": "3.809.941", "type": "CDM"}], "standard_charges": [{"gross_charge": 4989.6, "discounted_cash": 2993.76, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERSAL CLOSING HOOK  L 14-580921", "code_information": [{"code": "14-580921", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERSAL CLOSING HOOK  S 14-580920", "code_information": [{"code": "14-580920", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERSAL HANDLE 6971117 6971117", "code_information": [{"code": "6971117", "type": "CDM"}], "standard_charges": [{"gross_charge": 855.93, "discounted_cash": 513.56, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERSAL HANDLE G850000 TRI FLAT G850000", "code_information": [{"code": "G850000", "type": "CDM"}], "standard_charges": [{"gross_charge": 710.54, "discounted_cash": 426.32, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERSAL HOLDER 687.001", "code_information": [{"code": "687.001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4212.0, "discounted_cash": 2527.2, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERSAL HOOK  11MM 14-580911", "code_information": [{"code": "14-580911", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERSAL HOOK  16MM 14-580916", "code_information": [{"code": "14-580916", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERSAL HOOK  6MM 14-580906", "code_information": [{"code": "14-580906", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERSAL HOOK  8.5MM 14-580908", "code_information": [{"code": "14-580908", "type": "CDM"}], "standard_charges": [{"gross_charge": 1330.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UNIVERSAL REVERSE STEM SIZE 9 CAP COATED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "AR-9501-09CPC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9230.0, "discounted_cash": 5538.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UNL THER/PROP/DIAG INJ/INF", "code_information": [{"code": "96379", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTD NONINVAS VASC DX STD", "code_information": [{"code": "93998", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED ALL/IMMLG SVC/PX", "code_information": [{"code": "95199", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED ANES PROCEDURE", "code_information": [{"code": "1999", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CHEMISTRY PROCEDURE", "code_information": [{"code": "84999", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 212.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 426.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 426.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 403.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 300.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 103.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET 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"standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CV PX DX NUC MED", "code_information": [{"code": "78499", "type": "CPT"}], "standard_charges": [{"minimum": 1446.1, "maximum": 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52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 363.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 270.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 146.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 124.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CYTOPATHOLOGY PX", "code_information": [{"code": "88199", "type": "CPT"}], "standard_charges": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED DX GI PROCEDURE", "code_information": [{"code": "91299", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 164.3, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 329.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 329.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 347.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 312.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 232.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 380.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 323.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED E&M SERVICE", "code_information": [{"code": "99499", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED FETAL INVAS PX W/US", "code_information": [{"code": "59897", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED GI PX DX NUC MED", "code_information": [{"code": "78299", "type": "CPT"}], "standard_charges": [{"minimum": 1446.1, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED GU PX DX NUC MED", "code_information": [{"code": "78799", "type": "CPT"}], "standard_charges": [{"minimum": 1446.1, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED HEMATOLOGY&COAGJ PX", "code_information": [{"code": "85999", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 103.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 88.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED HOME VISIT SVC/PX", "code_information": [{"code": "99600", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED HYSTSC PX UTERUS", "code_information": [{"code": "58579", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED IMMUNE GLOBULIN", "code_information": [{"code": "90399", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED IN VIVO LAB SERVICE", "code_information": [{"code": "88749", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 103.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 88.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPAROSCOPIC PROCEDURE LIVER 47379", "code_information": [{"code": "47379", "type": "CPT"}, {"code": "4240120", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1490.5, "maximum": 14275.0, "gross_charge": 2710.0, "discounted_cash": 1626.0, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1490.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPAROSCOPY PROCEDURE ABDOMEN/PERITONEUM/OMENTUM 49329", "code_information": [{"code": "49329", "type": "CPT"}, {"code": "2759537", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 14275.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", 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"maximum": 14275.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF 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SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY 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total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee 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"BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX LYMPHTC SYS", "code_information": [{"code": "38589", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX RENAL", "code_information": [{"code": "50549", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 110.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 110.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 116.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 104.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 77.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 146.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 124.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MISC PX DX NUC MED", "code_information": [{"code": "78999", "type": "CPT"}], "standard_charges": [{"minimum": 267.05, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed 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"standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 536.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 536.37, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 564.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 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"standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MOLECULAR PATHOLOGY", "code_information": [{"code": "81479", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 261.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 261.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 275.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 248.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 184.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 492.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 418.24, "methodology": "fee schedule"}], 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1064.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2137.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2137.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LIVER", "code_information": [{"code": 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"standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CLIN BRACHYTX", "code_information": [{"code": "77799", "type": "CPT"}], "standard_charges": [{"minimum": 455.34, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 766.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1539.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1539.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1620.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1458.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1085.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 535.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 455.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CONJUNCTIVA", "code_information": [{"code": "68399", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 10356.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 4898.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 7198.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX DIAPHRAGM", "code_information": [{"code": "39599", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ENDOCRINE SYSTEM", "code_information": [{"code": "60699", "type": "CPT"}], "standard_charges": [{"minimum": 3408.0, "maximum": 8945.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 5168.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX EXTRAOCULAR MUSC", "code_information": [{"code": "67399", "type": "CPT"}], "standard_charges": [{"minimum": 1720.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX LACRIMAL SYSTEM", "code_information": [{"code": "68899", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX LUNGS & PLEURA", "code_information": [{"code": "32999", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MALE GENITAL SYS", "code_information": [{"code": "55899", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MAT CARE&DLVR", "code_information": [{"code": "59899", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MECKEL'S DVRTCLM", "code_information": [{"code": "44899", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MED RADJ PHYSICS", "code_information": [{"code": "77399", "type": "CPT"}], "standard_charges": [{"minimum": 496.24, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 583.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 496.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MEDIASTINUM", "code_information": [{"code": "39499", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 18989.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 8982.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 13197.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX NECK/THORAX", "code_information": [{"code": "21899", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX SMALL INTESTINE", "code_information": [{"code": "44799", "type": "CPT"}], "standard_charges": [{"minimum": 1987.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TEMPORAL BONE", "code_information": [{"code": "69979", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX THER RAD TX MGMT", "code_information": [{"code": "77499", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX THER RAD TX PLNG", "code_information": [{"code": "77299", "type": "CPT"}], "standard_charges": [{"minimum": 496.24, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 583.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 496.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TONGUE FLR MOUTH", "code_information": [{"code": "41599", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1987.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2918.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3990.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4200.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3780.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": 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"methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VASCULAR NJX", "code_information": [{"code": "36299", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VASCULAR SURGERY", "code_information": [{"code": "37799", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3330.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 6336.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4717.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VESTIBULE MOUTH", "code_information": [{"code": "40899", "type": "CPT"}], "standard_charges": [{"minimum": 1105.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee 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1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED REPROD MED LAB PROC", "code_information": [{"code": "89398", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 64.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 130.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 130.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 137.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 123.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 91.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 146.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 124.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED RESP PX DX NUC MED", "code_information": [{"code": "78599", "type": "CPT"}], "standard_charges": [{"minimum": 1446.1, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED SPEC DERM SVC/PX", "code_information": [{"code": "96999", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED SPECIAL SVC PX/RPRT", "code_information": [{"code": "99199", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", 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"standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 146.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 124.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED THERAPEUTIC PX", "code_information": [{"code": "97139", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED TRANSFUSION MED PX", "code_information": [{"code": "86999", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 73.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 62.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED URINALYSIS PX", "code_information": [{"code": "81099", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", 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5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 3344.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLOCKING TOOL CD102010", "code_information": [{"code": "CD102010", "type": "CDM"}], "standard_charges": [{"gross_charge": 181.38, "discounted_cash": 108.83, "setting": "both", "billing_class": "facility"}]}, {"description": "UNLSTD HEMATOP RET/ENDO LYMP", "code_information": [{"code": "78199", "type": "CPT"}], "standard_charges": [{"minimum": 1446.1, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX MAT CARE&DLVR", "code_information": [{"code": "59898", "type": "CPT"}], "standard_charges": [{"minimum": 3070.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3070.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 4511.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6166.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 6491.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 5842.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4349.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX SPRMATIC CORD", "code_information": [{"code": "55559", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNUSUAL PHYSICIAN TRAVEL", "code_information": [{"code": "99082", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNXPL CNST HRTBL DO GN XPRSN", "code_information": [{"code": "266U", "type": "CPT"}], "standard_charges": [{"minimum": 7964.32, "maximum": 9370.4, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 9370.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee 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"standard_charge_dollar": 23180.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 15456.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 13910.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 20862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPPER EXTREMITY CASE DISPOSABLES CC-148", "code_information": [{"code": "CC-148", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 798.0, "discounted_cash": 478.8, "setting": "both", "billing_class": "facility"}]}, {"description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC", "code_information": [{"code": "256", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12835.46, "maximum": 19209.95, "setting": "inpatient", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPR/L XTREMITY ART 2 LEVELS", "code_information": [{"code": "93922", "type": "CPT"}], "standard_charges": [{"minimum": 431.99, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 37.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 75.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 75.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 79.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 71.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 53.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 18.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 15.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UREA NITROGEN SEMI-QUANT", "code_information": [{"code": "84525", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 30.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 61.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 61.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 65.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 58.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 34.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 69.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 69.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 73.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 66.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 49.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 21.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 17.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & BIOPSY", "code_information": [{"code": "50974", "type": "CPT"}], "standard_charges": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2872.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2585.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL DILATOR SET 37CM 8 - 24FR", "code_information": [{"code": "G14185", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 850.19, "discounted_cash": 510.11, "setting": "both", "billing_class": "facility"}]}, {"description": "URETERAL EMBOLIZATION/OCCL", "code_information": 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"plan_name": "BCBS HMO DFW", "standard_charge_dollar": 9838.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 10356.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 6939.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL ENDOSCOPY THROUGH URETEROTOMY 50970", "code_information": [{"code": "50970", "type": "CPT"}, {"code": "1482338", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1185.8, "maximum": 8427.0, "gross_charge": 2156.0, "discounted_cash": 1293.6, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2773.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3790.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 3989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF 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"standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 572.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 572.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 602.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 542.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 403.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee 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"code_information": [{"code": "50630", "type": "CPT"}, {"code": "1482330", "type": "CDM"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7206.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6485.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 4828.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETEROLITHOTOMY-MIDDLE 1/3 OF URETER 50620", "code_information": [{"code": "50620", "type": "CPT"}, {"code": "1482331", "type": "CDM"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "gross_charge": 2793.0, "discounted_cash": 1675.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5008.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 6846.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 19.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 39.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 39.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 41.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 37.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 27.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 9.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINARY BLADDER RETENTION", "code_information": [{"code": "78730", "type": "CPT"}], "standard_charges": [{"minimum": 158.67, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 158.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 318.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 318.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 335.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 301.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 224.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 283.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 241.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINARY REFLEX STUDY", "code_information": [{"code": "51792", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINARY STONES WITH MCC", "code_information": [{"code": "693", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9715.22, "maximum": 16677.28, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 16677.28, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 9715.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINARY STONES WITHOUT MCC", "code_information": [{"code": "694", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5153.41, "maximum": 8862.64, "estimated_discounted_cash": 20568.86, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 8862.64, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 5153.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINE COLLECTION SYSTEM URIN-TEK 4202", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5070.0, "discounted_cash": 3042.0, "setting": "both", "billing_class": "facility"}]}, {"description": "URINE FLOW MEASUREMENT", "code_information": [{"code": "51736", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE SCREEN FOR BACTERIA", "code_information": [{"code": "81007", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 20.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 44.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 39.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 29.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 87.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 74.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE SHUNT TO INTESTINE", "code_information": [{"code": "50815", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE SPECIMEN COLLECT MULT", "code_information": [{"code": "P9615", "type": "HCPCS"}], "standard_charges": [{"minimum": 21.33, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 25.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 21.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROLIFT 2  HANDLE KIT W/ CARTRIDGE UL2-CHK", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "UL2-CHK", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3055.0, "discounted_cash": 1833.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UROLIFT 2 IMPLANT CARTIDGE UL2-C", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "UL2-C", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 881.25, "discounted_cash": 528.75, "setting": "both", "billing_class": "facility"}]}, {"description": "UROMAX ULTRA 18F (6MM) X 10CM", "code_information": [{"code": "M0062251170", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 618.85, "discounted_cash": 371.31, "setting": "both", "billing_class": "facility"}]}, {"description": "US ABDL AORTA SCREEN AAA", "code_information": [{"code": "76706", "type": "CPT"}], "standard_charges": [{"minimum": 281.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 281.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 564.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 564.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 594.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 534.69, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 398.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Abdomen Complete 76700", "code_information": [{"code": "76700", "type": "CPT"}, {"code": "625608", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 397.64, "maximum": 8427.0, "gross_charge": 1097.0, "discounted_cash": 658.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 603.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 515.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 548.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 570.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 554.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1113.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1113.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1171.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee 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"standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 427.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 858.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 858.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 903.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 813.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 605.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 380.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 323.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM INFANT HIPS STATIC", "code_information": [{"code": "76886", "type": "CPT"}], "standard_charges": [{"minimum": 186.29, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 186.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 374.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 374.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 393.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 354.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 263.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 380.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 323.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US EXAM K TRANSPL W/DOPPLER", "code_information": [{"code": "76776", "type": "CPT"}], "standard_charges": [{"minimum": 397.64, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 480.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 964.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 964.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1015.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 913.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 680.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Guidance Parenchymal Ablation 76940", "code_information": [{"code": "76940", "type": "CPT"}, {"code": "44626440", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 259.0, "maximum": 8427.0, "gross_charge": 1414.0, "discounted_cash": 848.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 777.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 664.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 707.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 735.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 259.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 520.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 520.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 547.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 492.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee 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schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 735.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 259.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 520.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 520.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 547.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 492.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 366.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US Guidance for Vascular Access 76937", "code_information": [{"code": "76937", "type": "CPT"}, {"code": "2031288", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 470.48, "maximum": 8427.0, "gross_charge": 1085.0, "discounted_cash": 651.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 596.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 509.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 542.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 564.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 470.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 944.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 944.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 994.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 895.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 666.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US Intraoperative 76998", "code_information": [{"code": "76998", "type": "CPT"}, {"code": "1748468", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 263.56, "maximum": 8427.0, "gross_charge": 638.0, "discounted_cash": 382.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 350.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 299.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 319.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 331.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 263.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 529.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 529.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 557.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 501.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 373.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US LE Arterial Duplex Uni Ltd 93926", "code_information": [{"code": "93926", "type": "CPT"}, {"code": "6606523", "type": "CDM"}, {"code": "929", "type": "RC"}], "standard_charges": [{"minimum": 220.43, "maximum": 8427.0, "gross_charge": 469.0, "discounted_cash": 281.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 257.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 220.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 234.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 243.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US LE Nonvascular Limited  Left 76882", "code_information": [{"code": "76882", "type": "CPT"}, {"code": "1715698", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 180.36, "maximum": 8427.0, "gross_charge": 494.0, "discounted_cash": 296.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 271.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 232.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 247.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 256.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 180.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 362.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US LE Nonvascular Limited Bl 76882", "code_information": [{"code": "76882", "type": "CPT"}, {"code": "1715697", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 180.36, "maximum": 8427.0, "gross_charge": 656.0, "discounted_cash": 393.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 360.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 308.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 328.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 341.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 180.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 362.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 362.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 381.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 343.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 255.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US LE Nonvascular Limited Rt 76882", "code_information": [{"code": "76882", "type": "CPT"}, {"code": "1715699", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 180.36, "maximum": 8427.0, "gross_charge": 494.0, "discounted_cash": 296.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 271.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 232.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 247.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 256.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 180.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 362.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 362.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 381.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 343.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee 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"standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 184.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 371.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 371.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 390.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 351.56, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 405.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 431.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 448.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 471.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 947.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 947.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 997.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 897.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 668.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}, {"minimum": 397.64, "maximum": 8427.0, "gross_charge": 934.0, "discounted_cash": 560.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 513.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 438.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 485.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 471.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 947.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 947.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 997.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 897.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 668.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Pelvis Non-OB Complete 76856", "code_information": [{"code": "76856", "type": "CPT"}, {"code": "630929", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 397.64, "maximum": 8427.0, "gross_charge": 934.0, "discounted_cash": 560.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 513.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 438.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 485.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 471.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 947.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 947.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 997.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 897.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 668.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Pelvis Non-OB Limited 76857", "code_information": [{"code": "76857", "type": "CPT"}, {"code": "630925", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 344.04, "maximum": 8427.0, "gross_charge": 732.0, "discounted_cash": 439.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 402.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 344.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 366.0, "methodology": "fee 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326.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 656.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 656.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 691.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 622.19, "methodology": "fee 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404.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 356.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 715.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 715.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 753.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"standard_charge_dollar": 375.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 399.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 415.48, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 403.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 809.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 809.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 852.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 766.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 570.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"standard_charge_dollar": 373.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 388.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 377.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 757.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 757.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 561.53, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1127.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1127.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1187.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1068.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 795.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US Spinal Canal and Contents 76800", "code_information": [{"code": "76800", "type": "CPT"}, {"code": "2031272", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 226.14, "maximum": 8427.0, "gross_charge": 776.0, "discounted_cash": 465.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 364.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 403.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 226.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 454.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 454.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 478.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 430.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 320.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US TRGT DYN MBUBB 1ST LES", "code_information": [{"code": "76978", "type": "CPT"}], "standard_charges": [{"minimum": 404.81, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 404.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 813.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 813.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 855.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 770.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 573.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 222.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 446.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 446.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 470.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 423.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 315.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US Transrectal 76872", "code_information": [{"code": "76872", "type": "CPT"}, {"code": "1172020", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 284.82, "maximum": 8427.0, "gross_charge": 606.0, "discounted_cash": 363.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 333.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 284.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 303.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 315.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 303.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 609.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 609.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 641.78, "methodology": "fee 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{"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 382.38, "maximum": 8427.0, "gross_charge": 843.0, "discounted_cash": 505.8, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 463.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 396.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 421.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 438.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 382.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 767.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 767.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 808.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 727.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER 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"standard_charge_dollar": 373.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 397.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 412.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 382.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 767.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 767.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 808.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 727.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 541.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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499.55, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVE 5.5MM CHANNEL A00001A", "code_information": [{"code": "A00001A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.61, "discounted_cash": 5.77, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVE CLEARLINK LUER ACTIVATED FOR IV 2N8399", "code_information": [{"code": "2N8399", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 7.7, "discounted_cash": 4.62, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVE GLAUCOME AHMED FLEXIBLE PLATE PEDIATRIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FP8", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVE SILICON GLAUCOMA IMPLANT", "code_information": [{"code": "C1783", "type": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY TRICUSPID", "code_information": [{"code": 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE BLEED", "code_information": [{"code": "37244", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 14567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE VENOUS", "code_information": [{"code": "37241", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 16185.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 16185.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1301.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2614.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2614.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2751.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2476.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1843.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASCULAR FLOW IMAGING", "code_information": [{"code": "78445", "type": "CPT"}], "standard_charges": [{"minimum": 243.91, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 243.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 489.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 489.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 515.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 464.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 345.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASCULAR STUDY", "code_information": [{"code": "93976", "type": "CPT"}], "standard_charges": [{"minimum": 397.64, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASECTOMY-UNILATERAL OR BILATERAL-INC. POST OP SEMEN EXAMINATION(S) 55250", "code_information": [{"code": "55250", "type": "CPT"}, {"code": "1482375", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 843.15, "maximum": 8427.0, "gross_charge": 1533.0, "discounted_cash": 919.8, "setting": "both", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3574.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5251.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "standard_charge_dollar": 843.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 7178.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 7556.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 6800.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5063.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3886.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 2481.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 4296.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 3866.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASOPRESSIN 20 UNITS/1 ML (MEDID)", "code_information": [{"code": "MED0232", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 441.08, "discounted_cash": 264.65, "setting": "both", 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"plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 12723.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN BYP GRFT FEM-POPLITEAL", "code_information": [{"code": "35583", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN BYP POP-TIBL PERONEAL", "code_information": [{"code": "35587", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1483.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 2566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 2309.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN LIGATION AND STRIPPING", "code_information": [{"code": "263", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17558.75, "maximum": 30420.38, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 30420.38, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR", "standard_charge_dollar": 17558.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN RETRACTOR 13MM WIDTH 389.501", "code_information": [{"code": "389.501", "type": "CDM"}], "standard_charges": [{"gross_charge": 1209.6, "discounted_cash": 725.76, "setting": "both", "billing_class": "facility"}]}, {"description": "VEIN X-RAY ADRENAL GLAND", "code_information": [{"code": "75840", "type": "CPT"}], "standard_charges": [{"minimum": 884.14, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 884.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1775.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1775.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1869.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1682.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1252.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ADRENAL GLANDS", "code_information": [{"code": "75842", "type": "CPT"}], "standard_charges": [{"minimum": 958.4, "maximum": 22498.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 958.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1924.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1924.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2026.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1823.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1357.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 22498.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 19122.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ARM/LEG", "code_information": [{"code": "75820", "type": "CPT"}], "standard_charges": [{"minimum": 306.95, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 306.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 616.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 616.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 648.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 584.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 434.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6512.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5535.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ARMS/LEGS", "code_information": [{"code": "75822", "type": "CPT"}], "standard_charges": [{"minimum": 438.28, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 438.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 880.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 880.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 926.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 833.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 620.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6512.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5535.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY CHEST", "code_information": [{"code": "75827", "type": "CPT"}], "standard_charges": [{"minimum": 977.35, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 977.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1962.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1962.98, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2066.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1859.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1384.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6512.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5535.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY EYE SOCKET", "code_information": [{"code": "75880", "type": "CPT"}], "standard_charges": [{"minimum": 1100.22, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1100.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2209.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2209.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2326.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2093.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1558.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2532.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2152.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY KIDNEY", "code_information": [{"code": "75831", "type": "CPT"}], "standard_charges": [{"minimum": 937.97, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 937.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1883.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1883.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1983.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1784.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1328.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY KIDNEYS", "code_information": [{"code": "75833", "type": "CPT"}], "standard_charges": [{"minimum": 972.2, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 972.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1952.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1952.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2055.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1849.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1377.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER", "code_information": [{"code": "75891", "type": "CPT"}], "standard_charges": [{"minimum": 743.78, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 743.78, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1493.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1493.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1572.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1415.21, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1053.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER W/HEMODYNAM", "code_information": [{"code": "75885", "type": "CPT"}], "standard_charges": [{"minimum": 644.11, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 644.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1293.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1293.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1361.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1225.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 912.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER W/HEMODYNAM", "code_information": [{"code": "75889", "type": "CPT"}], "standard_charges": [{"minimum": 910.66, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 910.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1828.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1828.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1925.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1732.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1289.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER W/O HEMODYN", "code_information": [{"code": "75887", "type": "CPT"}], "standard_charges": [{"minimum": 684.41, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 684.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1374.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1374.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1446.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1302.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 969.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY NECK", "code_information": [{"code": "75860", "type": "CPT"}], "standard_charges": [{"minimum": 914.24, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 914.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1836.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1836.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1932.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1739.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1295.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY SKULL", "code_information": [{"code": "75870", "type": "CPT"}], "standard_charges": [{"minimum": 865.82, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 865.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1738.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1738.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1830.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1647.46, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1226.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY SKULL EPIDURAL", "code_information": [{"code": "75872", "type": "CPT"}], "standard_charges": [{"minimum": 900.23, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 900.23, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1808.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1808.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1903.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1712.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1275.13, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2532.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2152.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY SPLEEN/LIVER", "code_information": [{"code": "75810", "type": "CPT"}], "standard_charges": [{"minimum": 1266.59, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1266.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2543.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2543.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2677.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2409.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1794.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY TRUNK", "code_information": [{"code": "75825", "type": "CPT"}], "standard_charges": [{"minimum": 1053.66, "maximum": 13040.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1053.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2116.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2116.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2227.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 2004.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1492.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 13040.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 11083.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEMP TEST I&R CERVICAL", "code_information": [{"code": "92517", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEMP TEST I&R OCULAR", "code_information": [{"code": "92518", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEMP TST I&R CERVICAL&OCULAR", "code_information": [{"code": "92519", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEN BLOOD COLL SNF/HHA", "code_information": [{"code": "G0471", "type": "HCPCS"}], "standard_charges": [{"minimum": 26.31, "maximum": 30.95, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 30.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 26.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEN MECHNL THRMBC REPEAT TX", "code_information": [{"code": "37188", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 5789.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 5210.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEN THROMBOSIS IMAGES BILAT", "code_information": [{"code": "78458", "type": "CPT"}], "standard_charges": [{"minimum": 534.93, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 534.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1074.37, "methodology": "fee schedule"}, {"payer_name": "BLUE 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"plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 757.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1701.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1446.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE CUTDOWN 1 YR/>", "code_information": [{"code": "36425", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE 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"standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE CUTDOWN < 1 YR", "code_information": [{"code": "36420", "type": "CPT"}], "standard_charges": [{"minimum": 109.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1887.0, "methodology": "fee 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"plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3590.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 1105.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENOUS MECH THROMBECTOMY", "code_information": [{"code": "37187", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 14275.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6752.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 9922.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13561.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14275.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 12848.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9564.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 8779.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 4213.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 8945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 8051.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENOUS SAMPLING BY CATHETER", "code_information": [{"code": "75893", "type": "CPT"}], "standard_charges": [{"minimum": 817.44, "maximum": 22498.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 817.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1641.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1641.8, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 22498.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 19122.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENOUS THROMBOSIS IMAGING", "code_information": [{"code": "78457", "type": "CPT"}], "standard_charges": [{"minimum": 267.44, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 267.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 537.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 537.18, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 565.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 508.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 378.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2208.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1877.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENT MGMT INPAT INIT DAY", "code_information": [{"code": "94002", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENT MGMT INPAT SUBQ DAY", "code_information": [{"code": "94003", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 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"methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 1 PROSTH", "code_information": [{"code": "34845", "type": "CPT"}], "standard_charges": [{"minimum": 1483.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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"0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 18040.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 18989.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 17090.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 3535.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 3004.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC CITY OF DALLAS", "standard_charge_dollar": 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 143.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 288.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 288.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 303.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 273.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 203.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 112.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 95.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIT D HYDROXY", "code_information": [{"code": "82306", "type": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 503.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 375.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 258.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 219.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VLCAD LEUK NZM ACTV WHL BLD", "code_information": [{"code": "257U", "type": "CPT"}], "standard_charges": [{"minimum": 1773.25, "maximum": 2086.31, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2086.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1773.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VLOC 180 ABS 2-0 CL 18 P-14 VLOCL0125", "code_information": [{"code": "VLOCL0125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 123.6, "discounted_cash": 74.16, "setting": "both", "billing_class": "facility"}]}, {"description": "VLOC 180 ABSORBABLE 2-0 ESTCH 4 LP VLOCA204L", "code_information": [{"code": "VLOCA204L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 236.21, "discounted_cash": 141.73, "setting": 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD VNVN CLTRL BELOW", "code_information": [{"code": "93588", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOL REDUCTION OF BLOOD/PROD", "code_information": [{"code": "86960", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": 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"methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 182.71, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 164.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 122.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 2.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOLTAGE-GTD CA CHNL ANTB EA", "code_information": [{"code": "86596", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 200.15, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 402.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 402.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 423.16, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 380.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 283.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 35.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 29.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOLUME DEPLETE OF HARVEST", "code_information": [{"code": "38214", "type": "CPT"}], "standard_charges": [{"minimum": 1659.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee 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"186300SND", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 573.0, "discounted_cash": 343.8, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SCREWINTERNAL DIA 3.3MM X OUTER DIA 6.5MM SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "219.972", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 162.65, "discounted_cash": 97.59, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SCRWINTERNAL DIA 4.6MM X OUTER DIA 10MM FOR CANNULATED SCREW DIAMETER 4.5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "219.91", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 144.85, "discounted_cash": 86.91, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SPIKED 13.5MM", "code_information": [{"code": "219.95S", "type": "CDM"}], "standard_charges": [{"gross_charge": 546.68, "discounted_cash": 328.01, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SPIKED 18MM FOR CANCELLOUS SCREW AND BI CORTICAL POST FOR FXTN OF SOFT TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1349L", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 572.0, "discounted_cash": 343.2, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SPIKEDINTERNAL DIA 6.5MM X OUTER DIA 13.5MM PEEK W/ BARIUM SULFATE AS X R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "219.951", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 546.68, "discounted_cash": 328.01, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER STAINLESS STEEL 7.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8870W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SURG 3MM THREADED FOR CANNULATED SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "219.89", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 457.88, "discounted_cash": 274.73, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER SURG 7MM TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8740W", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER USE WITH 2.0MM X 2.5MMMM SCREWS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSW02025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 475.84, "discounted_cash": 285.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WATER STERILE FOR INJECTION USP 1000 2B0304X", "code_information": [{"code": "2B0304X", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 9.74, "discounted_cash": 5.84, "setting": "both", "billing_class": "facility"}]}, {"description": "WATER STERILE NEBULIZER AQUAPACK", "code_information": [{"code": "44-28", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.55, "discounted_cash": 8.13, "setting": "both", "billing_class": "facility"}]}, {"description": "WATERJET PROSTATE ABLTJ CMPL", "code_information": [{"code": "421T", "type": "CPT"}], "standard_charges": [{"minimum": 4173.0, "maximum": 14483.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 6850.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 10066.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 13759.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 14483.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 13035.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 9704.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 5724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC DFW", "standard_charge_dollar": 7295.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC NEXUS", "standard_charge_dollar": 6566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WAVE DISTRACTION HANDLE WI-005", "code_information": [{"code": "WI-005", "type": "CDM"}], "standard_charges": [{"gross_charge": 570.97, "discounted_cash": 342.58, "setting": "both", "billing_class": "facility"}]}, {"description": "WAVE FUNNEL PUSHER WI-010", "code_information": [{"code": "WI-010", "type": "CDM"}], "standard_charges": [{"gross_charge": 339.16, "discounted_cash": 203.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WAVE FUNNEL PUSHER WI-010A", "code_information": [{"code": "WI-010A", "type": "CDM"}], "standard_charges": [{"gross_charge": 339.16, "discounted_cash": 203.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WAVE FUNNEL WI-009", "code_information": [{"code": "WI-009", "type": "CDM"}], "standard_charges": [{"gross_charge": 634.41, "discounted_cash": 380.65, "setting": "both", "billing_class": "facility"}]}, {"description": "WAVE FUNNEL WI-009A", "code_information": [{"code": "WI-009A", "type": "CDM"}], "standard_charges": [{"gross_charge": 634.41, "discounted_cash": 380.65, "setting": "both", "billing_class": "facility"}]}, {"description": "WAVE OBLIQUE FOOTPRINT GAUGE WI-051", "code_information": [{"code": "WI-051", "type": "CDM"}], "standard_charges": [{"gross_charge": 198.43, "discounted_cash": 119.06, "setting": "both", "billing_class": "facility"}]}, {"description": "WAVE RETRACTOR WI-008A", "code_information": [{"code": "WI-008A", "type": "CDM"}], "standard_charges": [{"gross_charge": 452.2, "discounted_cash": 271.32, "setting": "both", "billing_class": "facility"}]}, {"description": "WAX  BONE  WHITE  STERILE 903", "code_information": [{"code": "903", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.2, "discounted_cash": 9.12, "setting": "both", "billing_class": "facility"}]}, {"description": "WAX BONE 2.5 GRAMS W31G", "code_information": [{"code": "W31G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.1, "discounted_cash": 31.86, "setting": "both", "billing_class": "facility"}]}, {"description": "WAX BONE 2.5G NON-ABSORBABLE", "code_information": [{"code": "BW25G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.67, "discounted_cash": 16.6, "setting": "both", "billing_class": "facility"}]}, {"description": "WBC ALKALINE PHOSPHATASE", "code_information": [{"code": "85540", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 68.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 138.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 138.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 145.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 131.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 97.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 25.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 21.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WBC ANTIBODY IDENTIFICATION", "code_information": [{"code": "86021", "type": "CPT"}], "standard_charges": [{"minimum": 0.47, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "standard_charge_dollar": 0.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "standard_charge_dollar": 0.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 110.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 222.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 222.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 234.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 210.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 156.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 44.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 37.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WCD DEVICE INTERROGATE", "code_information": [{"code": "93292", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 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"type": "RC"}], "standard_charges": [{"gross_charge": 7800.0, "discounted_cash": 4680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE COTTON BONE 8 X 14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "PCOT-181408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6110.0, "discounted_cash": 3666.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE CUT GUIDE SP090033", "code_information": [{"code": "SP090033", "type": "CDM"}], "standard_charges": [{"gross_charge": 1304.64, "discounted_cash": 782.78, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE ELEVATOR 12MM X 25CM U40-675-12", "code_information": [{"code": "U40-675-12", "type": "CDM"}], "standard_charges": [{"gross_charge": 1196.64, "discounted_cash": 717.98, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE ELEVATOR 16MM X 25CM U40-675-16", "code_information": [{"code": 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"fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 566.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1138.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1138.57, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1198.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1078.64, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 803.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY BILE DUCT ENDOSCOPY", "code_information": [{"code": "74328", "type": "CPT"}], "standard_charges": [{"minimum": 574.58, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 574.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1154.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1154.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1214.76, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1093.28, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 813.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY BILE/PANC ENDOSCOPY", "code_information": [{"code": "74330", "type": "CPT"}], "standard_charges": [{"minimum": 942.19, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 942.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1892.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1892.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1991.94, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1792.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1334.59, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY CONSULTATION", "code_information": [{"code": "76140", "type": "CPT"}], "standard_charges": [{"minimum": 35.27, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 35.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 70.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 70.84, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 74.56, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 67.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 49.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF ARM INFANT", "code_information": [{"code": "73092", "type": "CPT"}], "standard_charges": [{"minimum": 92.25, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 92.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 185.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 185.29, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 195.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 175.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 130.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF BODY SECTION", "code_information": [{"code": "76100", "type": "CPT"}], "standard_charges": [{"minimum": 138.07, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 138.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 277.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 277.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 291.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 262.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 195.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF FEMUR 1", "code_information": [{"code": "73551", "type": "CPT"}], "standard_charges": [{"minimum": 112.88, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 112.88, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 226.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 226.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 238.61, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 214.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 159.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 380.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 323.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF FISTULA", "code_information": [{"code": "76080", "type": "CPT"}], "standard_charges": [{"minimum": 243.0, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 488.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 488.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 513.72, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 462.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 344.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2202.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1871.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF JAW JOINT", "code_information": [{"code": "70328", "type": "CPT"}], "standard_charges": [{"minimum": 81.14, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 81.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 162.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 162.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 171.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 154.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 114.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 380.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 323.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF JAW JOINT", "code_information": [{"code": "70332", "type": "CPT"}], "standard_charges": [{"minimum": 254.42, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 254.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 511.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 511.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 537.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 484.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 360.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1022.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 868.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF KIDNEY LESION", "code_information": [{"code": "74470", "type": "CPT"}], "standard_charges": [{"minimum": 188.81, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 188.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 379.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 379.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 399.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 359.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 267.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2202.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1871.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF LEG INFANT", "code_information": [{"code": "73592", "type": "CPT"}], "standard_charges": [{"minimum": 97.65, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 97.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 196.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 196.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 206.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 185.79, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 138.31, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 380.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 323.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF MASTOIDS", "code_information": [{"code": "70120", "type": "CPT"}], "standard_charges": [{"minimum": 135.41, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 135.41, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 271.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 271.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 286.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 257.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 191.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF MIDDLE EAR", "code_information": [{"code": "70134", "type": "CPT"}], "standard_charges": [{"minimum": 126.5, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 126.5, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 254.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 254.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 267.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 240.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 179.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2202.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1871.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF PENIS", "code_information": [{"code": "74445", "type": "CPT"}], "standard_charges": [{"minimum": 284.22, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 284.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 570.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 570.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 600.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 540.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 402.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF PERINEUM", "code_information": [{"code": "74775", "type": "CPT"}], "standard_charges": [{"minimum": 284.22, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 284.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 570.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 570.87, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 600.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 540.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 402.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1022.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 868.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF PERITONEUM", "code_information": [{"code": "74190", "type": "CPT"}], "standard_charges": [{"minimum": 384.11, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 384.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 771.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 771.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 812.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 730.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 544.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2202.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1871.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF SALIVARY DUCT", "code_information": [{"code": "70390", "type": "CPT"}], "standard_charges": [{"minimum": 192.04, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 192.04, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 385.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 385.75, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 406.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 365.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 272.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1022.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 868.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF TEAR DUCT", "code_information": [{"code": "70170", "type": "CPT"}], "standard_charges": [{"minimum": 384.11, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 384.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 771.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 771.47, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 812.1, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 730.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 544.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1022.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 868.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF TEETH", "code_information": [{"code": "70300", "type": "CPT"}], "standard_charges": [{"minimum": 80.45, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 80.45, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 161.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 161.58, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 170.07, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 153.06, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 113.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 380.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 323.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF TEETH", "code_information": [{"code": "70310", "type": "CPT"}], "standard_charges": [{"minimum": 115.19, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 115.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 231.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 231.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 243.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 219.19, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 163.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1022.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 868.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM PITUITARY SADDLE", "code_information": [{"code": "70240", "type": "CPT"}], "standard_charges": [{"minimum": 81.14, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 81.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 162.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 162.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 171.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 154.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 114.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 380.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 323.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM SURGICAL SPECIMEN", "code_information": [{"code": "76098", "type": "CPT"}], "standard_charges": [{"minimum": 85.09, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 85.09, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 170.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 170.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 179.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 161.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 120.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 2202.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 1871.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EYE FOR FOREIGN BODY", "code_information": [{"code": "70030", "type": "CPT"}], "standard_charges": [{"minimum": 199.97, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 199.97, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 401.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 401.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 422.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 380.49, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 283.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 380.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 323.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY FOR PANCREAS ENDOSCOPY", "code_information": [{"code": "74329", "type": "CPT"}], "standard_charges": [{"minimum": 766.11, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 766.11, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1538.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1538.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1619.67, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1457.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1085.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY GUIDE FOR GI TUBE", "code_information": [{"code": "74340", "type": "CPT"}], "standard_charges": [{"minimum": 147.83, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 147.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 296.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 296.9, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 312.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 281.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 209.38, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY GUIDE GI DILATION", "code_information": [{"code": "74360", "type": "CPT"}], "standard_charges": [{"minimum": 252.25, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 252.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 506.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 506.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 533.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 479.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 357.32, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY GUIDE INTESTINAL TUBE", "code_information": [{"code": "74355", "type": "CPT"}], "standard_charges": [{"minimum": 188.81, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 188.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 379.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 379.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 399.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 359.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 267.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY HEAD FOR ORTHODONTIA", "code_information": [{"code": "70350", "type": "CPT"}], "standard_charges": [{"minimum": 101.22, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 101.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 203.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 203.33, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 214.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 192.62, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 143.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 380.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 323.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY MALE GENITAL TRACT", "code_information": [{"code": "74440", "type": "CPT"}], "standard_charges": [{"minimum": 284.22, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 284.22, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 570.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 570.86, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 600.91, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 540.82, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 402.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1022.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 868.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY NOSE TO RECTUM", "code_information": [{"code": "76010", "type": "CPT"}], "standard_charges": [{"minimum": 81.14, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 81.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 162.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 162.95, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 171.54, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 154.39, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 114.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 380.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 323.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY OF MAMMARY DUCT", "code_information": [{"code": "77053", "type": "CPT"}], "standard_charges": [{"minimum": 223.27, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 223.27, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 448.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 448.43, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 472.03, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 424.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 316.26, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1022.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 868.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY OF MAMMARY DUCTS", "code_information": [{"code": "77054", "type": "CPT"}], "standard_charges": [{"minimum": 282.34, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 282.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 567.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 567.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 596.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 537.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 399.92, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 1022.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 868.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY SM INT F-THRU STD", "code_information": [{"code": "74248", "type": "CPT"}], "standard_charges": [{"minimum": 997.73, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 997.73, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 2003.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 2003.89, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 2109.35, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1898.42, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1413.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY STRESS VIEW", "code_information": [{"code": "77071", "type": "CPT"}], "standard_charges": [{"minimum": 81.14, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 81.14, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 162.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 162.96, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 171.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 154.4, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 114.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 380.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 323.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY XM ESOPHAGUS 2CNTRST", "code_information": [{"code": "74221", "type": "CPT"}], "standard_charges": [{"minimum": 163.77, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 163.77, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 328.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 328.93, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 346.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 311.63, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 231.99, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 789.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 670.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY XM PHRNX&/CRV ESOPH C+", "code_information": [{"code": "74210", "type": "CPT"}], "standard_charges": [{"minimum": 175.8, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 175.8, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 353.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 353.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 371.68, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 334.51, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 249.02, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 789.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 670.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAYS AT SURGERY ADD-ON", "code_information": [{"code": "74301", "type": "CPT"}], "standard_charges": [{"minimum": 188.81, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 188.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 379.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 379.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 399.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 359.25, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 267.44, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAYS BONE SURVEY LIMITED", "code_information": [{"code": "77074", "type": "CPT"}], "standard_charges": [{"minimum": 235.81, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 235.81, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 473.63, "methodology": "fee 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 334.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 467.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", "standard_charge_dollar": 397.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAYS TRANSCATH THERAPY", "code_information": [{"code": "75894", "type": "CPT"}], "standard_charges": [{"minimum": 1893.36, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH A/1", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 47.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH B/2", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 1893.36, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 3802.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 3802.7, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 4002.83, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 3602.55, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 2681.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-STEM IMPLANT STANDARD SIZE 3 LONG WITH TIDAL TECHNOLOGY 1834-0031", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1834-0031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9100.0, "discounted_cash": 5460.0, "setting": "both", "billing_class": "facility"}]}, {"description": "X-STEM IMPLANT TALL SIZE 3 1834-0130", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1834-0130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11970.23, "discounted_cash": 7182.14, "setting": "both", "billing_class": "facility"}]}, {"description": "X3 TRIATHLON CS 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"5531-G-609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9068.8, "discounted_cash": 5441.28, "setting": "both", "billing_class": "facility"}]}, {"description": "X3 TRIATHLON CS INS SIZE7 11MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-711", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4987.84, "discounted_cash": 2992.7, "setting": "both", "billing_class": "facility"}]}, {"description": "X3 TRIATHLON CS INS SIZE7 9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4987.84, "discounted_cash": 2992.7, "setting": "both", "billing_class": "facility"}]}, {"description": "X3 TRIATHLON CS INS SIZE8 9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5531-G-809", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4987.84, "discounted_cash": 2992.7, "setting": "both", "billing_class": "facility"}]}, {"description": "XBRAID S SZ 2-0 WJOTEB IE SITIRE CT-3 18 3910-900-036", "code_information": [{"code": "3910-900-036", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 103.2, "discounted_cash": 61.92, "setting": "both", "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL CPLX W/ECP", "code_information": [{"code": "66987", "type": "CPT"}], "standard_charges": [{"minimum": 3986.0, "maximum": 10329.0, "setting": "outpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 5856.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW-TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA DFW", "standard_charge_dollar": 10329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HIX", "standard_charge_dollar": 4173.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA MARKET SOLUTIONS", 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{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1107.24, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 996.52, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 741.85, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH C/3", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 52.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 820.2, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 1647.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 1647.34, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 1734.05, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 1560.65, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 1161.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XRAY ENDOVASC THOR AO REPR", "code_information": [{"code": "75957", 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"standard_charge_dollar": 3986.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BAV", "standard_charge_dollar": 208.66, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 419.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 419.08, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 441.12, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 397.01, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 5646.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREMIER HMO", "standard_charge_dollar": 295.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XRAY PLACE PROX EXT THOR AO", "code_information": [{"code": "75958", "type": "CPT"}], "standard_charges": [{"minimum": 467.6, "maximum": 8427.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA DFW", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS DFW", "standard_charge_dollar": 939.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 939.17, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS HMO DFW", "standard_charge_dollar": 8006.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 8427.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO DFW", "standard_charge_dollar": 988.6, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 889.74, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PPO-CITY OF DALLAS", "standard_charge_dollar": 7584.0, "methodology": "fee schedule"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", 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